Evaluating Conscious Sedation Versus General Anesthesia for Venous Sinus Stenting for Idiopathic Intracranial Hypertension and Implications for Outpatient Management: A Propensity Score-Matched Analysis.

Abstract

Venous sinus stenting (VSS) has emerged as a principal endovascular intervention for idiopathic intracranial hypertension (IIH). Diagnostic cerebral venography and manometry are typically performed under conscious sedation (CS), whereas VSS is frequently staged during a subsequent admission under general anesthesia (GA). Because most patients are discharged 24-48 hours post-VSS and growing evidence supports the safety and cost-effectiveness of outpatient neuroendovascular procedures, we evaluated the feasibility of performing these procedures under outpatient settings. We retrospectively included patients age ≥18 years who underwent VSS for IIH at our comprehensive cerebrovascular center between January 2017 and December 2024. Patient, presentation, and procedural characteristics, symptom resolution, and restenosis rates were compared before and after propensity score matching (PSM) among (1) GA vs CS and (2) single-session (same-admission diagnostic venography + VSS) vs staged procedures. We included 114 patients (mean age: 37.4 ± 11.3 years). The single major complication was a case of acute vision loss because of cerebral venous thrombosis in the CS cohort. No significant differences were found between GA and CS cohorts before (GA, n = 36; CS, n = 78) or after PSM (GA, n = 36; CS, n = 36) (all P > .05). The same-admission venography + VSS cohort included all 17 patients with fulminant IIH (characterized by acute, rapidly progressive symptoms) (same-admission, n = 37; staged-admission n = 77). Days to headache (1113.7 ± 943.8 vs 317.4 ± 200.1, P = .021) and visual symptom recurrence (1477.5 ± 1033.6 vs 358.5 ± 205.3, P = .045) were shorter in the same-admission cohort; the difference was not significant after PSM (same-admission, n = 37; staged-admission, n = 37). Restenosis requiring restenting occurred significantly more often in the same-admission cohort before and after PSM. Technical safety and feasibility of VSS were comparable between CS vs GA cohorts. Although same-admission venography + VSS was associated with higher restenting rates, further stratification by fulminant vs nonfulminant presentations may optimize patient selection for same-admission procedures. Staging outpatient venography and outpatient VSS would be feasible and practical.