Endovascular Treatment for Cerebral Venous Sinus Thrombosis: Comparison among Different Endovascular Procedures

Author:

Rangarajan Anush S1,Ramachandran Dileep1,Mishra Tanaya1,Gunaseelan Vikneshwaran2,Dash Gopal K.3,Philip Vivek J.3,Manohar Radhika3,Shetty Kuldeep3,Thomas Pavin3,Huded Vikram1

Affiliation:

1. Department of Interventional Neurology, NH Institute of Neurosciences, NH Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India

2. Department of Clinical Research, Narayana Hrudayalaya Ltd, Bengaluru, Karnataka, India

3. Department of Neurology, NH Institute of Neurosciences, NH Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India

Abstract

Background: Cerebral venous sinus thrombosis (CVST) is a rare, treatable cause of stroke. Even though CVST has an established medical treatment, 15% of patients remain refractory to treatment. These patients may be candidates for endovascular treatment (EVT), yet the selection of patients remains a challenge. The study aims to understand the profile and outcome of patients treated with EVT and the type of procedure associated with good outcomes. Methods: This is a single-center, retrospective analysis of CVST patients who underwent EVT from 2009 till 2022. Patients who received only medical management were excluded. Modified Rankin Scale (mRS) ≤2 at 3 months was taken as the primary outcome. Secondary outcomes assessed were hospital stay, death, recurrence, mRS ≤ 2 at discharge, and angiographic recanalization. Results: Fifty-two patients were included. Twenty-eight (53.8%) were males; the mean age was 33.3 ± 12.3 years. Headache (n = 44, 84.6%) predominated among the symptoms. The common risk factors were anemia (n = 13, 25.5%) and hyperhomocysteinemia (n = 13, 25.5%). Worsening of sensorium (n = 21, 40.3%) and non-improvement of symptoms (n = 15, 28.8%) were the common indications for the procedure. Twenty-five (48.1%) people underwent in situ thrombolysis (IST). Death occurred in eight (15.3%) patients. Thirty-six (73.5%; 36/49) patients had a good outcome at 3 months. IST had a significantly better outcome (mRS ≤ 2, n = 20, 80%) compared to other procedures (P = 0.04). Hospital stay was lesser in the IST subgroup, but without statistical significance. Midline shift >5 mm (odds ratio [OR] 6.8 [1.5–30.9], P = 0.01) and Glasgow Coma Scale <9 before the procedure (OR 27.2 [3.1–236.4], P = 0.002) predicted bad outcomes at 3 months. Female gender (OR 4.5 [1.07–8.8], P = 0.03), presence of altered sensorium (OR 10.2 [1.2–87.5], P = 0.01), encephalopathic syndrome (P = 0.02), presence of parenchymal bleed (OR 3.7 [0.9–4.5], P = 0.04), and midline shift (OR 4.8 [1.1–20.2], P = 0.03) were associated with poor outcome at discharge. Conclusion: EVT yielded good outcomes in carefully selected, medically refractory patients of CVST. IST performed well compared to other procedures.

Publisher

Medknow

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