Author’s Disclosure Block: Adrien Lusterio, none; Jim Shenchu Xie, none; Lele Xiao, none; Brendan Tao, none; Jaya Sharma, none; Edward Margolin, none

Abstract Body
Purpose: This meta-analysis aimed to evaluate the visual, clinical, and stent-related outcomes in patients with idiopathic intracranial hypertension (IIH) undergoing venous sinus stenting (VSS). Study Design: Systematic review and meta-analysis. Methods: A comprehensive literature search was performed across PubMed, CENTRAL, and Embase. We included studies that reported safety or efficacy outcomes in at least 5 patients diagnosed with IIH who underwent venous sinus stenting. We evaluated the following post-stenting outcomes: reductions in intracranial pressure (ICP)-lowering pharmacotherapy, headache, pulsatile tinnitus, transient visual obscurations (TVO), diplopia, papilledema, visual acuity (VA), visual fields (VF), and retinal nerve fiber layer (RNFL) thickness. Stent-related outcomes, including patency, restenosis, thrombosis, symptom recurrence, complications, and need for repeat surgery were also analyzed. Data were pooled using random-effects models, and statistical heterogeneity was evaluated using the I² statistic. Results: Of 3573 retrieved records, we included 60 studies with a total of 2,562 patients. Of these, 86% were female, with a mean age of 35.5 years (SD 3.4). VSS led to significant reductions in medication use, with 81% of patients (95% CI: 67–91%) discontinuing ICP-lowering medications. Headaches improved and resolved in 80% (95% CI: 78–83%) and 56% (95% CI: 40–70%) of cases, respectively. Pulsatile tinnitus resolved in 93% (95% CI: 80–98%). TVO resolved in 92% (95% CI: 74–98%), and diplopia resolved in 90% (95% CI: 72–97%). Papilledema improved in 98% (95% CI: 95–100%) and resolved in 93% (95% CI: 82–98%). Pooled data post-stenting represented improvements in VA of 0.08 logMAR (95% CI: 0.04–0.12), a decrease in RNFL thickness by 78.2 μm (95% CI: 43.64–112.77), and complete resolution of visual field deficits in 56% (95% CI: 33–77%). Stent patency was maintained in 97% (95% CI: 96–99%). Restenosis occurred in 5% (95% CI: 3–8%), and stent thrombosis was observed in 2% (95% CI: 1–3%). Repeat surgery occurred in 9% (95% CI: 7–13%). Major complications such as intracranial hemorrhage or hematoma were reported in 0.5% (95% CI: 0.26–0.96%). Conclusion: Venous sinus stenting is associated with significant reductions in medication dependence, headaches, visual outcomes, and papilledema in patients with IIH. Stent patency is high, with a low rate of complications, supporting its role as an effective intervention for IIH with vision-threatening symptoms.