{ "abstract": "Introduction Idiopathic intracranial hypertension (IIH) is a substantial and growing source of morbidity. Venous sinus stenting (VSS) is gaining acceptance for the management of selected, medically refractory patients. However, recurrence rates of over 25% have been reported, and durability data are limited. We describe long-term clinical, ophthalmological and radiological outcomes in a large, consecutive cohort of IIH patients treated with VSS.Materials & Methods We retrospectively analysed a prospectively maintained, single-centre registry of consecutive adults (age ≥ 18) with medically refractory IIH undergoing VSS. Allowing for at least three years of follow-up, patients treated between November 19, 2014 and February 14, 2023 were included. Demographic, clinical, radiological and procedural data were collected at baseline, six months and then annually thereafter.Results We included 104 patients, of which 96 (92.3%) were female. Mean age and BMI was 34.0 (±10.8) years and 37.1kg/m 2 (±9.4), respectively. Presenting symptoms included headache (98.1%), visual disturbance (93.3%) and pulsatile tinnitus (86.5%). The mean lumbar puncture opening pressure was 33.2cmH2O (±9.9) and adjunctive angioplasty was performed in 20 (19.2%) patients. The mean trans-stenotic gradient decreased from 8.7mmHg (±6.3) to 1.4mmHg (±2.6) after VSS placement. Follow-up lumbar punctures and catheter angiograms were performed at a mean of 9.1 (±9.9) months. The mean opening pressure was 21.8cmH2O (±6.4), representing a mean reduction of 11.4cmH2O (±10.4). There was no stenosis in 68 of the 85 patients with catheter angiographic follow-up (80.0%), with 12 (14.1%), three (3.5%) and two (2.4%) having proximal interface, in-stent or distal stenosis, respectively. Final follow-up was conducted at a mean of 58.6 (±26.6) months. At this time, almost three-quarters (73.6%) of patients reported headache improvement and 61 (93.9%) had resolution of papilledema. Visual symptoms and tinnitus had improved in 50 (72.5%) and 48 (77.4%) patients, respectively. Visual symptoms (21.7%) and headache (20.8%) were the most common symptoms to recur. Delayed improvement was most frequently observed for visual symptoms (11.6%), but was very uncommon for headaches (4.2%), papilledema (3.1%) and tinnitus (4.8%). Early and delayed follow-up CT venography was conducted at a mean of 13.4 (±17.3) and 45.5 (±29.5) months. Of those with delayed non-invasive imaging, early interface, in-stent or distal stenosis was identified in 16 patients (25.0%). At final radiological follow-up, 10 patients (18.2%) had stable stenosis when compared to intra-procedural or early post-procedural imaging and 11 (20.4%) had new or progressive stenosis. Fifteen (14.4%) patients underwent retreatment, at a median of 16.4 (2.5-129.3) months after the index procedure. Eight of these patients had progressive stent-adjacent stenosis, three had treatment of the contralateral side and the remainder had additional bilateral stents placed.Conclusion Among the largest reported cohort with long-term follow-up of VSS for IIH, we demonstrate sustained clinical and ophthalmological benefit over a mean follow-up period of five years. Papilledema recurrence and radiological progression were rare, with acceptable retreatment rates. However, a quarter of patients experienced no headache benefit. These findings provide robust long-term evidence supporting the safety and durability of venous sinus stenting and should inform patient selection, counselling and longitudinal surveillance strategies.Disclosures T. O’Donohoe: None. J. Rosenthal: None. E. Aguilar: None. R. Bram: None. W. Wroe: None. H. Taylor: None. M. Ramos: None. A. Abou-Hamden: None. T. Kleinig: None. A. Davidson: None. H. Asadi: None. O. Adesina: None. C. Woon: None. R. Tang: None. P. Chen: None.", "authors": [ { "affiliations": [ "Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX" ], "name": "T O’Donohoe" }, { "affiliations": [ "Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX" ], "name": "J Rosenthal" }, { "affiliations": [ "Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX" ], "name": "E Aguilar" }, { "affiliations": [ "Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX" ], "name": "R Bram" }, { "affiliations": [ "Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX" ], "name": "W Wroe" }, { "affiliations": [ "Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX" ], "name": "H Taylor" }, { "affiliations": [ "Eye Wellness Center, Houston, TX" ], "name": "M Ramos" }, { "affiliations": [ "Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia" ], "name": "A Abou-Hamden" }, { "affiliations": [ "Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia" ], "name": "T Kleinig" }, { "affiliations": [ "Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia" ], "name": "A Davidson" }, { "affiliations": [ "Department of Radiology, Austin Health, Melbourne, Australia" ], "name": "H Asadi" }, { "affiliations": [ "Department of Ophthalmology, University of Texas Health Science Center at Houston, Houston, TX" ], "name": "O Adesina" }, { "affiliations": [ "Whitsett Vision Group, Houston, TX" ], "name": "C Woon" }, { "affiliations": [ "Eye Wellness Center, Houston, TX" ], "name": "R Tang" }, { "affiliations": [ "Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX" ], "name": "P Chen" } ], "title": "O-056 Long-term follow-up after venous sinus stenting for idiopathic intracranial hypertension", "uid": "a6707cb2-638e-5fc5-bea4-f26fa0a9f988" }