BACKGROUND: Venous sinus stenting (VSS) has emerged as a novel treatment option for idiopathic intracranial hypertension (IIH) with transverse sinus stenosis (TSS). However, the efficacy of stenting in atypical IIH patients (body mass index [BMI] <
24 kg/m METHODS: The data of IIH + TSS patients who experienced conventional medical treatment failure and received VSS treatment at Beijing Tiantan Hospital in China between May 2021 and December 2022 were retrospectively reviewed in a prospectively maintained database. Baseline characteristics and periprocedural features were collected, and follow-up clinical outcomes (intracranial pressure [ICP], stent-adjacent stenosis, and symptoms and ophthalmic improvements) were compared between typical and atypical patients. RESULTS: Data were available for 24 IIH + VSS patients. The median age was 37 years, and 95.8% were female. There were 9/24 atypical patients (37.5%). At baseline, atypical patients had milder visual field defects than typical patients did, as reflected by the mean deviation (MD) of the worse eye (median of -3.08 decibel (dB) vs. -7.63 dB, p = 0.027). Periprocedurally, 1-2 carotid self-expandable stents with 7-9 mm in length and 40-50 mm in diameter were deployed at the site of the TSS. The median follow-up duration was 12 months (range 8-22 months). At the last visit of follow-up, stenting intervention significantly decreased the ICP and grade of papilledema and improved the best corrected visual acuity in the worse eye and MD in the fellow eye in both typical and atypical patients. The clinical outcomes of typical and atypical IIH + TSS patients were not significantly different, except that the MD of the worse eye in the atypical group was greater than that in the typical group (-1.33 dB vs. -5.31 dB, p = 0.001). CONCLUSIONS: This study indicates a considerable proportion of atypical IIH cases among IIH + TSS patients with conventional medical treatment failure. Moreover, VSS seems to be an effective and safe therapeutic modality for atypical IIH + TSS.