Ross Hauser, MD
For some patients, stenting may improve blood flow through the jugular veins and reduce symptoms, at least for a period of time. In selected cases, it can be an effective treatment. However, when narrowing appears to be related to external compression – such as nearby bony structures or other anatomical factors – stenting alone may be less effective because it does not address the source of the compression.
A 2018 study in the European Journal of Neurology (1) examined patients with internal jugular vein stenosis and symptoms associated with intracranial hypertension, particularly in cases where brain imaging did not show clear intracranial abnormalities. In that small group of 15 patients, stenting was associated with improved blood flow and short-term improvement in symptoms such as headache, tinnitus, papilledema, and elevated intracranial pressure. At one year, many patients continued to report improvement.
A 2023 study in the Annals of Clinical and Translational Neurology (2) also reported symptom improvement after stenting in a larger group of patients with venous stenosis. In patients who underwent stenting, blood flow improved immediately after the procedure, and many reported improvement in symptoms such as headache, tinnitus, insomnia, visual problems, and papilledema over follow-up.
When the problem may involve structures outside the vein
Some researchers have emphasized that venous narrowing is not always a simple problem within the vein itself. A 2018 paper in CNS Neuroscience and Therapeutics (3) discussed extracranial venous abnormalities, including cases in which the internal jugular vein may be affected by surrounding structures. The authors noted that clinical presentation can vary and that diagnosis often depends on combining multiple imaging methods.
An August 2024 study in Neurosurgery (4) looked at placing a stent in a narrowed internal jugular vein in patients with cerebral venous outflow problems, many of whom had an underlying connective tissue disorder. In fact, about 69% of patients had a connective tissue disorder, suggesting this was a highly selected group. The findings also raise the possibility that cervical posture, instability, or changes in spinal alignment may contribute to stent failure. Although about three quarters of patients improved at first, only about one third had lasting benefit. The procedure also had a fairly high complication rate.
That paper also suggested that endovascular treatment, including angioplasty and stenting, may help some patients. At the same time, it noted that when there is clear external compression of the internal jugular vein – for example from the styloid process, nearby muscle structures, or adjacent vertebral anatomy – surgery to address the compressing structure may be considered in selected cases. In patients with identified external impingement between the styloid process and the lateral mass of C1, the paper reported that stenting alone was considered less effective because the narrowing was compressive in nature.
A 2025 review (5) of surgical treatment for cervical internal jugular vein compression published in the Journal of clinical neuroscience found that the published evidence remains limited and is based mainly on case reports and small single-center series, but it also identified styloidectomy as the most commonly described surgical intervention
A January 2026 retrospective surgical series reported in the journal World Neurosurgery (6) symptomatic improvement in a majority of carefully selected patients undergoing styloidectomy for jugular decompression, while also noting frequent complications and the need for additional interventions in some cases.
In addition to our findings listed below, some clinicians have proposed that cervical posture, instability, or changes in spinal alignment may contribute to altered venous outflow in certain patients.
Can you stent a stretched-out vein? When vein narrowing is caused by a stretched-out vein? What are we seeing in this image?
A blue balloon is used to demonstrate stenosis of a different kind. The stretched-out or elongated vein stenosis. This is stenosis caused by cervical spine instability and a loss of the natural cervical spine curve. Look at the blue balloon in its normal resting state on the left. Note how much wider it is than the eleven inches, a stretched-out version of itself on the right. The stretched-out version of itself has less inner space for the blood to drain.
The vein is represented by the blue balloon. When the balloon is stretched to 9 inches it has more space for the blood to flow than when it is stretched to 11 inches. A narrowing occurs. The more stretching of the vein the less space is contained within the vein for the blood flow and for drainage of fluids that need to be moved out of the brain.
The main danger of brain venous congestion is that it increases intracranial pressure, this pressure is then transmitted to the brain’s arteries, which then increases blood flow to ensure adequate oxygenation of the brain. If the blood vessels cannot respond because of their obstruction in the neck, then brain ischemia can ensue.
The brain’s blood vessels may initially be able to respond via autoregulation (increases in blood vessel diameter in the brain) for a time, but if the cervical/brain venous congestion continues because of cervical dysstructure and cervical instability, the increased intracranial pressure will eventually damage the brain neurons, and ultimately, the brain tissue itself.
While the most common cause of arterial or venous obstruction in patients seen at Caring Medical is narrowing caused by cervical instability, it can also be from autonomic nervous dysfunction. Autonomic nervous dysfunction or dysautonomia can cause detrimental changes in the arterial blood flow to the brain or venous blood flow out.
One reason is that the vein is getting stretched out in the neck. How? One way is that the patient’s head is moving forward on their shoulders. When the head is in this position, the veins get pulled on and stretched out. This narrows the veins. A narrowed vein has less room for blood and fluid to flow through.
Summary
When stenting fails in internal jugular vein compression, it often means the stent did not solve the underlying mechanical problem. If the vein is still being squeezed from the outside – for example by bone, muscle, posture, instability, or abnormal motion in the neck – the stent may not stay open enough to give lasting relief. In some patients, symptoms improve at first but return because the compression persists, the stent narrows again, the stent shifts, or surrounding anatomy changes with head and neck position. This may be especially relevant in people with connective tissue disorders, where tissue laxity or cervical instability can make the anatomy more dynamic.
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Our published research
Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability
Summary and contact us. Can we help you? How do I know if I’m a good candidate?
We hope you found this article informative and that it helped answer many of the questions you may have surrounding the challenges that internal jugular vein stenosis may be causing you. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.
References
1 Zhou D, Meng R, Zhang X, Guo L, Li S, Wu W, Duan J, Song H, Ding Y, Ji X. Intracranial hypertension induced by internal jugular vein stenosis can be resolved by stenting. European journal of neurology. 2018 Feb;25(2):365-e13. [Google Scholar]
2 Bai C, Chen Z, Ding Y, Ji X, Yuan J, Meng R. Long‐term safety and efficacy of stenting on correcting internal jugular vein and cerebral venous sinus stenosis. Annals of Clinical and Translational Neurology. 2023 Aug;10(8):1305-13. [Google Scholar]
3 Zhou D, Ding JY, Ya JY, Pan LQ, Yan F, Yang Q, Ding YC, Ji XM, Meng R. Understanding jugular venous outflow disturbance. CNS neuroscience & therapeutics. 2018 Jun;24(6):473-82. [Google Scholar]
4 Fargen KM, Midtlien JP, Belanger K, Hepworth EJ, Hui FK. The promise, mystery, and perils of stenting for symptomatic internal jugular vein stenosis: a case series. Neurosurgery. 2024 Aug;95(2):400-7. [Google Scholar]
5 Petersingham G, Shrestha N, Elliott M, Allan RS, Parker G, Van Camp L, Rao PJ. Invasive surgical management of cervical internal jugular venous compression: A literature review. Journal of Clinical Neuroscience. 2025 Jul 1;137:111304. [Google Scholar]
6 Midtlien JP, Ashraf O, Yager B, Margraf CR, Wiater AH, Chang E, Ehrig M, Kittel C, Siddiqui A, Hui FK, Hepworth EJ. Styloidectomy for jugular decompression in venous outflow disorders. World Neurosurgery. 2025 Dec 12:124717. [Google Scholar]