Migratory Venous Sinus Stenosis After Stenting for Idiopathic Intracranial Hypertension: a Single-Center Case Series

Venous sinus stenting (VSS) is an effective intervention for medically refractory idiopathic intracranial hypertension (IIH) with hemodynamically significant dural venous sinus stenosis. However, some patients develop de novo stenosis in venous segments that were angiographically normal at the index procedure-a phenomenon we define as migratory venous sinus stenosis (mVSS). We aimed to characterize the incidence, anatomical distribution, and clinical management of symptomatic mVSS in a consecutive VSS cohort.

We retrospectively reviewed of all consecutive IIH patients who underwent VSS at West China Hospital (November 2011-October 2025). Patients developing symptomatic mVSS were identified, and clinical presentations, anatomical localization, hemodynamic parameters, and treatment outcomes were analyzed.

Among 65 patients, 4 (6.2%) developed symptomatic mVSS (3 women, 1 man; age range 15-44 years). Symptom recurrence occurred 4 days to 9 months after index VSS. New stenoses localized to the venous segment immediately distal to the original stent in all cases. Recurrent trans-stenotic pressure gradients ranged from 16 to 30 mm Hg (manometry was unavailable in one patient). Three patients underwent successful repeat stenting with immediate hemodynamic normalization and durable symptom resolution. One patient with concurrent paraspinal infection improved with conservative management alone.

Symptomatic mVSS is an uncommon but clinically significant failure mode after VSS for IIH, characteristically arising at or immediately beyond the distal stent margin. Structured post-stenting surveillance and timely consideration of repeat intervention are warranted in symptomatic cases.