Stenting versus medical treatment for idiopathic intracranial hypertension based on a propensity score matching method.

Background: In recent years, stenting has been widely used to treat patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS); however, research comparing stenting and medical treatment (MT) remains scarce. This study aimed to evaluate the effectiveness of stenting and MT in treating patients with IIH and VSS.

Methods: In this single-center, retrospective, cohort study, the clinical data of patients diagnosed with IIH and VSS at The First Affiliated Hospital of Zhengzhou University from January 2018 to June 2023 were collected for analysis. Based on the treatment approaches, the patients were divided into the following two groups: the stenting group (Group S), and the MT group (Group M). The patients underwent 1:1 propensity score matching (PSM) to compare the improvement in papilledema Frisén grade, lumbar puncture opening pressure (LPOP), and clinical symptoms after treatment.

Results: In total, 128 participants were included in the study. The participants had an average age of 40.0±11.1 years (range, 18-61 years) and a body mass index (BMI) of 27.5±3.3 kg/m² (range, 20.0-40.0 kg/m²), and 73.43% were female (68 in Group S and 60 in Group M). Compared with the patients in Group M, those in Group S had a longer median time from onset to treatment (2 vs. 1 month, P=0.026), a higher proportion of papilledema (85.3% vs. 68.3%, P=0.033), a higher median pretreatment stenosis rate (80% vs. 70%, P=0.005), and a larger median pretreatment trans-stenotic pressure gradient (15.5 vs. 11.0 mmHg, P=0.001), and a larger median pretreatment LPOP (391.1 vs. 350.5 mmH₂O, P=0.006). Following 1:1 PSM, both groups comprised 28 patients each, and there were no statistically significant differences between the two groups in terms of the covariates (all P>0.05). Compared with the patients in Group M, those in Group S had a lower median papilledema Frisén grade (1 vs. 2, P=0.002) and average LPOP (213.0 vs. 259.8 mmHg, P=0.003) at discharge, and showed more pronounced symptom improvement at the time of discharge (P=0.019), and at 6 months (P=0.011) and 12 months (P<0.001) post-discharge.

Conclusions: The research indicated that stenting was quicker and more effective in alleviating papilledema, LPOP, and corresponding symptoms and signs than MT.