Internal jugular vein stenting for symptomatic severe rotational stenosis

BACKGROUND: Dynamic internal jugular vein (IJV) stenosis is increasingly recognized in patients with cerebral venous outflow disorders (CVD). Although the hemodynamic effects of dynamic jugular stenosis have been characterized, its role in disease remains undefined. This study evaluated the safety and early outcomes of IJV stenting for symptomatic rotational stenosis. METHODS: This retrospective, single-institution study included adult patients that underwent IJV stenting for dynamic, symptomatic IJV stenosis between 2023 and 2025. Inclusion required dynamic venography demonstrating >75% rotational IJV stenosis and ≥6 mmHg trans-stenotic pressure gradient. Demographic, procedural, and clinical data were analyzed. Symptom severity was assessed using the Cerebral Venous Disorder Symptom Severity (CVDSS) scale and the Headache Impact Test (HIT-6). RESULTS: Sixteen patients (mean age 37.1 years, 75% female) were included. All underwent successful IJV stent placement without periprocedural complications. The median trans-stenotic pressure gradient improved from 7 mmHg (range 6-18) to 1 mmHg (range 0-9) after stenting. CVDSS scores improved from 13.5 (11.0-16.0) to 8.5 (4.75-12.0) at peak improvement (p<0.001), with sustained improvement (10.5 (8.0-12.3), p<0.001) at a median follow-up of 10.1 months. Median HIT-6 scores decreased from 65.5 (64.0-67.3) to 61.0 (57.0-64.0) (p<0.001). Thirteen patients reported meaningful symptom improvement at last follow-up, and 88% were satisfied with their decision to pursue stenting. CONCLUSION: Jugular vein stenting in refractory CVD patients with severe, symptomatic rotational IJV stenosis is technically feasible and associated with meaningful clinical improvement in patients though partial symptom recurrence is common. Optimal patient selection and procedural expertise are essential to maximize patient safety and efficacy.