Venous collateral drainage patterns predict clinical worsening in dural venous sinus thrombosis. (6th March 2017)

• Record Type: Journal Article
• Authors: Sheth, Sunil A; Trieu, Harry; Liebeskind, David S; Saver, Jeffrey L; Szeder, Viktor; Jahan, Reza; Tateshima, Satoshi; Duckwiler, Gary
• Is Part Of: Journal of neurointerventional surgery. Volume 10:Number 2(2018)
• Page Start: 171
• Page End: 175
• Publication Date: 2017-03-06
• Subjects: Hemorrhage -- Angiography -- Blood Flow -- Vein; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2016-012941
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: Dural venous sinus thrombosis (DVST) is an increasingly recognized cause of a wide array of neurological symptoms, with outcomes that range from complete recovery to death. The condition of approximately 23% of patients with DVST will worsen after initial presentation, as a result of restricted venous outflow and venous hypertension, but early identification of this subset is challenging. A venous collateral scale (VCS) that grades alternative drainage routes may improve prediction of clinical deterioration. Objective: To examine the ability of the VCS system to accurately identify patients with DVST who will experience clinical worsening, based on their imaging at presentation. Methods: From our institutional database, we identified patients with DVST on dedicated venous imaging between January 2010 and July 2016. A VCS was created and calculated from venous imaging at presentation by two reviewers blinded to subsequent data. Results: The 27 patients who met the inclusion criteria for this study had a median age of 42 years and 14 (52%) were female. Initial symptoms included headache without hemorrhage in 30% and focal deficit in 30%. Transverse sinus occlusion was present in 70% and superior sagittal sinus occlusion in 41%. VCS was 0 in 11%, 1 in 37%, and 2 in 52%. A lower VCS was significantly associated with clinical worsening both from time of initial symptom onset (77% vs 29%, VCS 0–1 vs 2, p<0.05) and during hospitalization (62% vs 0%, VCS 0–1 vs 2, p<0.01). In multivariate analysis, VCS but no other presenting features was significantly associated with in-hospital worsening (OR=2, p<0.01). Conclusions: The type and quality of venous collaterals influence outcome in DVST. VCS helps to identify patients whose condition is likely to deteriorate and may need additional aggressive interventions.