Endovascular treatment for cerebral venous sinus thrombosis – a single center study. (4th May 2021)

• Record Type: Journal Article
• Authors: Andersen, Thomas Hasseriis; Hansen, Klaus; Truelsen, Thomas; Cronqvist, Mats; Stavngaard, Trine; Cortsen, Marie Elisabeth; Holtmannspötter, Markus; Højgaard, Joan L Sunnleyg; Stensballe, Jakob; Welling, Karen Lise; Gutte, Henrik
• Is Part Of: British journal of neurosurgery. Volume 35:Number 3(2021)
• Page Start: 259
• Page End: 265
• Publication Date: 2021-05-04
• Subjects: Cerebral venous sinus thrombosis -- endovascular therapy -- intracranial hemorrhage -- recanalization -- outcome; Nervous system -- Surgery -- Periodicals; 617.48
• DOI: 10.1080/02688697.2020.1786498
• Languages: English
• ISSNs: 0268-8697

Abstract

Abstract: Background: Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disorder. The majority of these patients respond favorably to systemic anticoagulation. However, a subset of patients will deteriorate clinically, despite optimal medical therapy. Methods: Retrospective single center study of 28 consecutive CVST patients treated with systemic anticoagulation and additional endovascular therapy. Results: Median age was 37.5 years (range 15–76 years), there were 21 (75%) women, and 20 (71%) had thrombosis involving ≥2 venous sinuses. Intracranial hemorrhage (ICH) was present at admission in 18 patients (64%). Endovascular therapy consisted of local thrombolysis in 26 (93%) patients; 9 patients (32%) had additional mechanical thrombectomy, and in 2 (7%) patients thrombectomy alone was performed. Complete recanalization at end of the final intervention was achieved in 15 patients (54%), partial recanalization in 11 patients (39%), whereas there was no recanalization in 2 patients (7%). On follow-up imaging, conducted between 3 and 6 months, recanalization further improved to 76%, 19% and 5%, respectively. A favorable outcome (mRS ≤ 2) was achieved in 63% of patients at 3 months, which improved to 79% at 6 months. Post-procedural ICH or volume expansion of preexisting ICH was seen in 9 patients (32%). In total 5 patients died (18%). Conclusions: Systemic anticoagulation with the addition of endovascular therapy with local thrombolysis and/or mechanical thrombectomy is a potential strategy to obtain recanalization in patients with CVST who deteriorate clinically despite medical therapy or are comatose. Endovascular therapy may increase the risk of ICH.