Venous sinus stenting for pulsatile tinnitus secondary to venous sinus stenosis: a dual-center retrospective cohort study

Pulsatile tinnitus (PT) can emerge due to stenosis in the venous sinus, which leads to turbulent venous flows and increased pressures within the veins. Stenting of the venous sinus (VSS) is a potential intervention to relieve PT and is considered minimally invasive, as it restores proper venous flow. To evaluate the clinical, hemodynamic, and radiological outcomes of venous sinus stenting (VSS) in a real-world cohort of patients with pulsatile tinnitus (PT) and venous sinus stenosis, and to describe the symptom-imaging-manometry framework used for procedural selection in routine practice. From January 2018 to December 2024, we conducted a dual-center, retrospective cohort study of 30 consecutive adults with PT who underwent transverse sinus stenting. Secondary outcomes included changes in trans-stenotic venous pressure gradient, early 1-month change in LP opening pressure, radiologic resolution, papilledema improvement, procedure-related complications, and recurrence. Thirty patients were included (28 females; mean age 39.0 ± 13.1 years). PT was right-sided in 50.0%, left-sided in 16.7%, and bilateral in 33.3%. Mean pre-stent trans-stenotic pressure gradient was 7.0 ± 1.4 mmHg and decreased significantly after stenting (P < 0.001). LP opening pressure decreased from 39.93 ± 10.99 before stenting to 18.23 ± 3.87 cm H₂O at 1 month after stenting (P < 0.001). Immediate complete symptom resolution occurred in 27 patients (90%); the remaining 3 patients (10%) achieved complete resolution by 12 months of follow-up. Follow-up MRV demonstrated resolution of the treated venous sinus stenosis, with restored sinus caliber/patency in all patients. Minor complications occurred in 3 patients (10%) (ecchymosis 6.7%, epistaxis 3.3%), with no major adverse events or recurrence. VSS was associated with a significant reduction in venous pressure gradient and LP opening pressure, along with high durable PT resolution rates and a low rate of minor complications in this cohort.