Sequential Contralateral Venous Sinus Stenting for Persistent or Recurrent Symptoms Following Unilateral Stenting: A...

Cerebral venous sinus stenting (CVSS) is an established treatment for idiopathic intracranial hypertension (IIH) and pulsatile tinnitus (PT). Despite frequent bilateral venous sinus stenosis, treatment is typically unilateral, and data on sequential contralateral stenting for persistent or recurrent symptoms remain limited.

To report safety and clinical outcomes of sequential contralateral CVSS in patients with incomplete or recurrent symptom improvement after technically successful unilateral stenting.

We conducted a retrospective single-center case series of patients who underwent contralateral CVSS between January 2019 and April 2025. Headache, papilledema, visual field defects, and PT were assessed using ordinal severity scales and a composite symptom severity score. Radiological findings, venous pressure gradients, procedural details, and complications were recorded. Longitudinal symptom severity changes were analyzed using nonparametric testing.

Among 118 patients treated with unilateral CVSS, 16 (14%) underwent sequential contralateral stenting. All patients were female, with a median age of 30.5 (25-42) years. Papilledema resolved after the first CVSS and did not recur. Following contralateral CVSS, improvement occurred across symptom domains, including headache and PT, with complete resolution of significant visual field defects. The composite symptom severity score improved from 7 (5-9) before the first CVSS to 3 (2-3) after the procedure and to 1 (0-2) after contralateral stenting (P<0.0001). No intra- or post-procedural complications occurred.

In selected patients with persistent or recurrent symptoms after unilateral CVSS, sequential contralateral stenting appears safe and provides meaningful clinical benefit, supporting consideration of this approach and the need for prospective evaluation.