Abstract TP311: Does Severe Obesity Impact Cerebral Venous Sinus Stenting Outcomes?

Introduction: Idiopathic intracranial hypertension (IIH) is a chronic, debilitating condition that typically affects obese women of childbearing age. Higher BMI has been associated with a higher risk of IIH and of its most disabling complication, permanent vision loss. There is still limited evidence on how higher BMI may impact procedural and clinical outcomes in cerebral venous sinus (CVS) stenting for IIH-induced venous hypertension. Hypothesis: Severe obesity may affect CVS stenting outcomes in patients with IIH refractory to medical management. Methods: We performed a retrospective analysis of a multicentric prospectively-maintained registry of patients with medically refractory IIH who underwent venous manometry and CVS stenting. Patients were divided into two groups according to their body mass index (BMI): those with BMI < 40 kg/m 2 , and those with BMI ≥ 40 kg/m 2 . We compared venous pressure gradient resolution (post-stenting mean pressure gradient of 0-3 mmHg), need for restenting by 12 months, and rates of improvement of papilledema, tinnitus, and headache. Results: Three hundred and fourteen patients with IIH underwent CVS stenting, among whom 107 were severely obese (BMI ≥ 40 kg/m 2 ), and 207 had normal to moderately high BMI. Baseline characteristics were similar across the two groups, except for a lower frequency of contraceptive use (p < 0.05) and a higher prevalence of obstructive sleep apnea (p < 0.001) in severely obese patients. Post-stenting venous pressure gradient resolution and rates of symptom improvement were not significantly different across groups. There was a higher but nonsignificant trend of patients requiring re-stenting among severely obese patients (p = 0.14). Conclusions: Compared to those with BMI < 40, our IIH patients with severe obesity had no significant difference in stenting outcomes. Although re-stenting rates were low in both groups, there was a nonsignificant trend towards the need for re-stenting in severely obese patients. This trend highlights the importance of lifestyle modifications and weight loss after venous stenting. Future analysis of IIH with severe obesity will evaluate BMI change after stenting in a larger cohort.