Abstract / Summary
Abstract Purpose The optimal pressure gradient threshold for venous sinus stenting (VSS) in idiopathic intracranial hypertension (IIH) remains controversial, partly due to non-standardized measurement techniques. This study evaluated the feasibility and safety of high-fidelity microcatheter manometry guided venous sinus stenting, and explored its early clinical outcomes compared with ventriculoperitoneal (VP) shunting. Methods Between 2016 and 2025, 105 patients with IIH were evaluated, of whom 35 were refractory to pharmacological therapy. Thirteen patients underwent VP shunting. Fifteen underwent VSS guided by a predefined trans-stenotic pressure gradient threshold of ≥ 8 mmHg. In five of these patients, parallel pressure measurements were obtained using microcatheter-based and fluid-based techniques. Clinical and safety outcomes were assessed at 90 days. Results High-fidelity microcatheter manometry was feasible in all cases. Pre-stenting sinus gradients had a median of 20 mmHg (range 8–31) with a median reduction of 14 mmHg after stenting. In paired testing (n = 5), the high-fidelity system consistently measured higher gradients than the fluid-filled technique (2–25 vs 4–30 mmHg; p < 0.05). Bland–Altman analysis demonstrated systematic underestimation by the fluid-filled method, with increasing discrepancy at higher gradients. At 90 days, stable or improved visual acuity occurred in 93.3% of stented patients and 61.6% of shunted patients (p = 0.069). Complications were less frequent after VSS (6.7% vs 46.2%; p = 0.0286). Conclusions High-fidelity microcatheter manometry is feasible and reveals systematic underestimation of pressure gradients by conventional techniques. In this exploratory analysis, VSS demonstrated early outcomes comparable to VP shunting with fewer complications. Standardized physiological assessment may refine treatment selection in IIH.