Impact of Stent Length on Stenosis and Outcomes in Venous Sinus Stenting

Introduction Cerebral venous sinus stenting (VSS) is an established treatment for transverse sinus (TS) stenosis associated with idiopathic intracranial hypertension (IIH). Our early practice favored shorter stents that spanned the focal narrowing. However, stent‐adjacent stenosis (SAS) emerged as a failure mode prompting use of longer constructs. In this study, we sought to compare the incidence of SAS, clinical outcomes, and angiographic findings between shorter and full‐length stents. Methods A retrospective analysis was conducted of 60 IIH patients that underwent VSS at our center from 2013‐2023. Symptom presentation, neuroimaging, venous manometry, pre‐operative and follow‐up angiography and clinical examination findings were recorded and analyzed across two categories of stent length: shorter (40 or 60 mm) and full‐length (80 mm). SAS was defined as de‐novo narrowing of the TS contiguous with the stent edge. Results Endovascular treatment was successfully performed in all 60 patients (48 females, mean age of 39 years). 3 patients were treated with 40 mm, 13 with 60 mm, and 44 with full‐length 80 mm stents. SAS was encountered in 8 patients (13%); this was significantly more frequent (P<0.01) in shorter stents (6/16), with 3 requiring re‐intervention using a second overlapping stent. Of the 44 patients with full‐length constructs, 2 patients demonstrated SAS at residual unstented TS lateral to the torcula. After a mean follow‐up duration of 40 months, 29 patients (48%) reported persistent symptoms, without a significant difference between groups. Full‐length constructs demonstrated a more favorable post‐operative reduction (P<0.01) in TS pressure gradients and lower gradients (P<0.05) on follow‐up. Conclusion Stent‐adjacent stenosis is a clinically relevant complication following VSS in IIH patients and may contribute to persistent symptoms and need for re‐intervention. Full‐length stent constructs extending from the sigmoid sinus to the torcula significantly reduce the incidence of SAS and are associated with better hemodynamic outcomes following VSS.