Endovascular Venous Sinus Stenting versus CSF Shunting for Idiopathic Intracranial Hypertension: Nationwide Real-World Outcomes

BACKGROUND AND PURPOSE:

Endovascular venous sinus stenting (VSS) is a promising new treatment for select patients with idiopathic intracranial hypertension (IIH) refractory to medical management. This study aims to investigate the safety and efficacy of VSS compared to neurosurgical CSF shunting in real-world clinical practice.

MATERIALS AND METHODS:

This was a retrospective cohort study of the 2016-22 Nationwide Readmissions Database in the United States. Adult patients who underwent elective IIH treatment with VSS or CSF shunting were identified. Propensity score matching (PSM) was performed to balance treatment groups. The primary outcome was IIH treatment failure, defined as hospital readmission for IIH-related symptoms, hardware complications, repeat surgery, or death within 300 days. Safety outcomes include morbidity and mortality, both peri-procedurally and during follow-up. Rates of perioperative ischemic strokes, intracranial hemorrhage (ICH), and death were also assessed.

RESULTS:

7,795 patients were identified; 1,511 (19.3%) underwent VSS. After PSM, 1,370 VSS and 2,786 CSF shunting patients remained. VSS was associated with a lower rate of treatment failure (HR 0.59 [95%CI 0.43-0.80], p<0.001). The risk of morbidity/mortality was lower in the VSS group, both peri-procedurally (2.2% vs. 5.5%, p<0.001) and throughout study follow-up (HR 0.38 [95%CI 0.25-0.58], p<0.001). Rates of periprocedural ischemic stroke, ICH, and death were low for both cohorts (<1% for all).

CONCLUSIONS:

In this nationally representative study of real-world hospitalization data in the United States, endovascular VSS is associated with lower rates of treatment failure compared to conventional CSF shunting, as well as lower risk of morbidity and mortality. These findings provide real-world evidence that VSS is a safe and effective alternative to neurosurgical CSF shunting in select IIH patients. ABBREVIATIONS: VSS = venous sinus stenting; IIH = idiopathic intracranial hypertension; CSF = cerebrospinal fluid; PSM = propensity score matching; ICH = intracranial hemorrhage.