Epidemiology, Endovascular Treatment, and Prognosis of Cerebral Venous Thrombosis: US Center Study of 152 Patients

Abstract

BackgroundCerebral venous thrombosis is a rare cause of stroke that poses diagnostic, therapeutic, and prognostic challenges. Mainstay treatment is systemic anticoagulation, but endovascular treatment is increasingly advocated. Our objectives were to describe the epidemiology, treatment, and prognosis of 152 patients with cerebral venous thrombosis.Methods and ResultsThis was a retrospective study of consecutive cerebral venous thrombosis cases from 2006 to 2013 at a comprehensive stroke center through hospital discharge. Predictors of full recovery (modified Rankin Scale scores 0–1) were analyzed with multiple logistic regression and presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The population was young (average age: 42 years), majority female (69%), and commonly presenting with cerebral edema (63%), and 72% were transferred in. All patients received systemic anticoagulation; 49% (n=73) required endovascular treatment. Reasons for requiring endovascular treatment included cerebral edema, herniation, or hemorrhagic infarct (n=38); neurologic decline (n=17); rethrombosis, persistent occlusion, or clot propagation (n=10); extensive clot burden (n=7); and persistent headache despite anticoagulation (n=1). There were 7 (10%) procedural complications. Recanalization was successful (61%), partial (30%), and unsuccessful (9%). Overall, 60% fully recovered. Positive predictors of full recovery included hormonal etiology, particularly for patients who were transferred in (AOR: 7.06 [95% CI, 2.27–21.96], interaction P=0.03) and who had migraine history (AOR: 4.87 [95% CI, 1.01–23.50], P=0.05), whereas negative predictors of full recovery were cerebral edema (AOR: 0.11 [95% CI, 0.04–0.34], P<0.001) and motor weakness (AOR: 0.28 [95% CI, 0.09–0.96], P=0.04).ConclusionsAs one of the largest cohort studies, our findings suggest that cerebral edema, history of migraine, and hormonal etiology were prognostic and that endovascular treatment might be a safe and effective treatment for cerebral venous thrombosis when conventional management is inadequate.

Cerebral venous thrombosis requiring invasive treatment for elevated intracranial pressure in women with combined hormonal contraceptive intake: risk factors, anatomical distribution, and clinical presentation

“…The endovascular treatment complication rate is described in the literature as approximately 10%, with a full recovery rate of 60%. 27 Therefore, endovascular intervention in this setting constitutes a valuable treatment option in selected cases. However, the optimal method to regain recanalization is yet to be determined.…”

“…However, the optimal method to regain recanalization is yet to be determined. 4,20,24,25,27 In some cases, progressive cerebral edema and expansion of hemorrhagic infarcts lead to refractory ICP after surgical decompression. In our case series, ICP monitoring and management were carried out in accordance with current guidelines to attain ICP levels below 20 mm Hg.…”

“…14,15,18 Endovascular treatment options using modern approaches are emerging within this context and seem to be safe and effective when conventional management fails. 4,20,24,25,27 Retrospective and prospective observational studies suggest that early decompressive surgery prevents death and does not result in an excess of severe disability, 14,34 but specific data on additional medical treatment in CVT remain scarce. 9,11 In particular, the use of barbiturate coma and induced hypothermia in patients with refractory ICP due to CVT has not been described in the literature.…”

Thrombus in the Superior Sagittal Sinus Was Successfully Aspirated by Coaxial Catheter Technique: A Technical Case Report

“…1) Anticoagulant therapy reduces the mRS score to 0-2 after 3 months in 94%-95% of patients; 4,5) an improvement in the outcome therapy to promptly and accurately achieve sinus recanalization. As predictors of a severe status or poor outcome, a National Institutes of Health Stroke Scale (NIHSS) score of ≥3 after admission, 6) motor paralysis or sensory disturbance on the initial consultation, 7) brain edema, 8) and an insufficient collateral pathway around the occluded sinus 9) have been reported. In the present case, the condition on arrival was not severe, but brain edema and motor paresis were noted, suggesting that the condition may become severe.…”

Clinical presentations, diagnosis and treatment of cerebral vein and sinus thrombosis

“…В Итальянский регистр входят данные 706 случаев тромбоза МВ и ВС [8]. Одно из последних ретроспективных исследований [9], включающее 152 больных с тромбозом МВ и ВС, было проведено в 2017 г.…”