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Background Venous sinus stenting has emerged as an effective treatment for cerebral venous outflow disorders (CVD), historically targeting transverse and superior sagittal sinus stenoses. However, the existence, prevalence, and clinical relevance of straight sinus stenosis is unknown. This study investigates the prevalence of straight sinus stenosis and pressure gradients in patients with CVD, and it reports the first two cases of straight sinus stenting for this condition.Methods This retrospective single-center study included medically-refractory CVD patients that underwent diagnostic cerebral venography with manometry with attempted straight sinus catheterization for measuring straight sinus stenosis and pressure gradients between April and June 2025.Results Fifty-one patients underwent cerebral venography with manometry with attempted straight sinus catheterization. The mean age was 41.1 years, and 44 (81.6%) patients were female. Thirty-eight patients (74.5%) underwent successful straight sinus catheterization. The mean straight sinus gradient was 2.6 mmHg (range 0–7), with 30.6% exhibiting gradients 4 mmHg or greater, and 11.1% 6 mmHg or greater. In 41.7% of patients, straight sinus apex pressures exceeded superior sagittal sinus pressures. No complications were observed. Two patients underwent straight sinus stenting for medically refractory symptoms with favorable short-term outcomes.Conclusion Straight sinus pressure gradients are common in patients with CVD, with a substantial proportion demonstrating physiologically significant gradients. Straight sinus catheterization is safe and feasible, and preliminary experience suggests that stenting at this location may be an effective and well-tolerated treatment in select patients. Further studies are warranted to assess long-term outcomes and define selection criteria for intervention.