TY - JOUR

T1 - Endovascular treatment for cerebral venous sinus thrombosis – a single center study

AU - Andersen, Thomas Hasseriis

AU - Hansen, Klaus

AU - Truelsen, Thomas

AU - Cronqvist, Mats

AU - Stavngaard, Trine

AU - Cortsen, Marie Elisabeth

AU - Holtmannspötter, Markus

AU - Højgaard, Joan L Sunnleyg

AU - Stensballe, Jakob

AU - Welling, Karen Lise

AU - Gutte, Henrik

PY - 2021

Y1 - 2021

N2 - BackgroundCerebral 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.MethodsRetrospective single center study of 28 consecutive CVST patients treated with systemic anticoagulation and additional endovascular therapy.ResultsMedian 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%).ConclusionsSystemic 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.

AB - BackgroundCerebral 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.MethodsRetrospective single center study of 28 consecutive CVST patients treated with systemic anticoagulation and additional endovascular therapy.ResultsMedian 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%).ConclusionsSystemic 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.

U2 - 10.1080/02688697.2020.1786498

DO - 10.1080/02688697.2020.1786498

M3 - Journal article

C2 - 32648493

VL - 35

SP - 259

EP - 265

JO - British Journal of Neurosurgery

JF - British Journal of Neurosurgery

SN - 0268-8697

IS - 3

ER -