A 33-year-old female with obesity and IIH status post venous stent 9 years prior presented with worsening headaches over several weeks. Headaches were worse when lying flat and associated with visual floaters. Neurologic exam was non-focal and ophthalmologic exam revealed trace optic disc edema. CTV was notable for a left transverse sinus stent with nonocclusive thrombus in the medial aspect causing 2 cm of severe stenosis. She had been on dual antiplatelet therapy (DAPT) for 1 year after her stent placement only, but currently was not on any medications. She was treated in the same manner as a cerebral venous thrombosis (CVT) with systemic anticoagulation. 

No standard guidelines exist regarding anti-thrombotic therapy or monitoring. With placements of stents elsewhere (venous or arterial), it is common practice patients end up on lifelong anti-thrombotic therapy after de-escalation from DAPT. This should be adopted as standard practice to prevent complications and secondary exacerbations of disease state.