What is the rate of in-stent restenosis for transvenous stenting in Idiopathic Intracranial Hypertension (IIH) during short-term and long-term follow-up?

From the Guidelines

The rate of in-stent stenosis for transvenous stenting in IIH is approximately 10.2% at short-term follow-up, with higher rates of up to 30% reported in some studies during short-interval follow-up 1.

Short-term Follow-up

In the short term, in-stent stenosis occurs in around 10.2% of patients, as reported in a series of 78 patients with 82 symptomatic intracranial stenoses treated with the Wingspan intracranial stent system 1. This rate is concerning and highlights the need for close monitoring of patients after stenting procedures.

Long-term Follow-up

While the provided evidence does not specifically report long-term follow-up rates for in-stent stenosis in IIH patients, it is essential to consider that the durability of the stenting technology and approach to treatment may be a concern, with high rates of early restenosis reported in some studies 1.

Factors Influencing In-Stent Stenosis

Several factors can influence the development of in-stent stenosis, including stent size, venous anatomy, and individual patient characteristics. However, the provided evidence does not specifically address these factors in the context of IIH patients.

Management and Monitoring

To minimize the risk of in-stent stenosis, regular imaging follow-up is crucial. Although the provided evidence does not specify the recommended follow-up protocol for IIH patients, it is generally recommended to monitor patients closely after stenting procedures to detect any potential complications early.

Key Considerations

• The rate of in-stent stenosis at short-term follow-up is a significant concern, with reported rates of approximately 10.2% 1.
• The durability of the stenting technology and approach to treatment may be a concern, with high rates of early restenosis reported in some studies 1.
• Close monitoring of patients after stenting procedures is essential to detect any potential complications early.

From the Research

In-Stent Stenosis Rates for Transvenous Stenting in IIH

• The rate of in-stent stenosis for transvenous stenting in Idiopathic Intracranial Hypertension (IIH) is not directly reported in the provided studies.
• However, study 2 reports that at least 20% of patients developed restenosis following dural venous sinus stent (DVSS) insertion at 120 days.
• Study 3 mentions that complications associated with stenting included in-stent stenosis or thrombosis, but does not provide a specific rate.
• Study 4 reports that patients undergoing stent-assisted angioplasty had a higher rate of restenosis (46%) compared to those undergoing balloon-assisted angioplasty (18%) during long-term follow-up.
• Study 5 reports that the incidence of ≥50% in-stent stenosis is relatively high, but the rates of ≥80% stenosis and late neurologic events are low.

Short-Term and Long-Term Follow-Up

• Study 2 reports outcomes at 3-4 months after DVSS insertion, with a stent survival rate of 87.8% at 120 days.
• Study 4 reports restenosis rates at 1 year and long-term follow-up, with 27% of vessels showing ≥70% restenosis at 1 year and 18% at long-term follow-up.
• Study 5 reports rates of freedom from ≥50% and ≥80% in-stent stenosis at 1,2,3,4, and 5 years, with 70% and 89% freedom from ≥50% and ≥80% stenosis, respectively, at 5 years.
• Study 3 reports that a recurrence of symptoms requiring a follow-up surgical intervention occurred in 9% of patients.