Baseline factors associated with post-stenting intracranial pressure in patients with idiopathic intracranial hypertension with venous sinus stenosis.

Background: Venous sinus stenting is an effective treatment for idiopathic intracranial hypertension (IIH) with venous sinus stenosis (VSS), which can reduce intracranial pressure (ICP) and alleviate symptoms. The present study aimed to investigate the associations between baseline characteristics and 6-month post-stenting ICP (hereinafter referred to as ICP6M).

Methods: Data from a prospective cohort of patients with IIH + VSS who received venous sinus stenting and a 6-month follow-up at a tertiary medical institution in China between January 2017 and June 2023 were analyzed. Demographic features, clinical manifestations, VSS characteristics and pre-stenting transstenotic gradients were collected. At the 6-month follow-up, improvements in symptoms and signs, and the ICP were evaluated. Independent factors associated with ICP6M were identified.

Results: A total of 104 patients (median age 35.0 years, 83.7% female) were included in the study. After adjustment for sex, disease duration, pre-stenting transstenotic gradient, Frisen Grade of both eyes, symptoms of visual disturbance, sinus dominance, and stenosis side, patients with extrinsic stenosis (β = 32.88, 95% confidence interval [CI] 14.16-51.60) had greater ICP6M values. Age (β = -0.98, 95% CI -1.88 to -0.08) was negatively associated with ICP6M, whereas body mass index (BMI, β = 3.88, 95% CI 1.95-5.81) and pre-stenting ICP (β = 0.35, 95% CI 0.12-0.57) were positively associated with ICP6M.

Conclusion: This study demonstrated that stenosis type, age, BMI, and pre-stenting ICP are independent predictors of ICP6M in stented patients with IIH + VSS. Close monitoring should be directed towards patients with extrinsic stenosis, younger age, higher BMI, and higher pre-stenting ICP, as these patients may have higher post-stenting ICP and subsequently poorer outcomes.