ARISE II Consensus on Venous Sinus Stenting

In recent years, venous sinus stenosis has been shown to be a key underlying contributor to idiopathic intracranial hypertensions (IIH) and the most common cause of pulsatile tinnitus (PT). Recent advancements in noninvasive venous imaging have improved the detection of venous sinus stenosis in IIH patients, and growing evidence supports a pathophysiological relationship between venous sinus stenosis, reduced cerebrospinal fluid (CSF) absorption, and elevated intracranial pressure (ICP) in a substantial subset of this population. The growing use of venous sinus stenting (VSS) as an effective treatment for sequelae of venous sinus stenosis highlights the importance of developing standardized, evidence-based diagnostic and management guidelines. A multidisciplinary roundtable of academic, government, and industry cerebrovascular experts convened at the ARISE II meeting to discuss existing evidence and develop areas of expert consensus. These discussions focused on developing standardized patient selection, diagnostic evaluation, procedural considerations, and post-treatment follow-up for VSS. Expert consensus supports VSS as a safe and effective therapy for appropriately selected patients with venous sinus stenosis. The recommendations discussed in this paper aim to standardize patient care, optimize outcomes, and identify opportunities for further investigation.