Influence of Recanalization on Outcome in Dural Sinus Thrombosis

Abstract

Background and Purpose-Recanalization in dural sinus thrombosis (DST) has been observed previously; however, systematic prospective data are lacking. The influence of recanalization on DST outcome has not yet been thoroughly evaluated. Methods-Thirty-seven consecutive patients with DST were prospectively examined. Neurological deficits were graded with the National Institutes of Health Stroke Scale (NIHSS) on hospital admission and discharge. Functional outcome was assessed with the modified Rankin Scale (mRS) on hospital discharge and after 12 months. All patients were treated with intravenous heparin in the acute stage of illness, followed by oral anticoagulation for 12 months. Imaging follow-up with MR angiography and, in a few cases, with CT or conventional angiography was performed on hospital discharge and after 6 and 12 months. Results-Twelve-month functional outcome was excellent in 89% of patients with an mRS of 0 or 1. A recanalization rate of 60% was already observed on hospital discharge (22Ϯ6 days); thereafter, recanalization rates increased insignificantly. Early recanalization was not related to NIHSS score on hospital discharge or an mRS of 0 on discharge or after 12 months. Conclusions-We found a high frequency of early recanalization but without influence on clinical outcome parameters.Frequent imaging follow-ups in DST are not useful because they provide no information on patient outcome.

Venous Thromboembolic Events After Cerebral Vein Thrombosis

“…18 Furthermore, no significant differences in relapses or outcome were found in those with incomplete or no recanalization. 19,20 In our study, baseline imaging features such as location and thrombus load were not associated with thrombotic recurrence.…”

Diagnosis and Management of Cerebral Venous Thrombosis

“…Partial or complete recanalization rates for CVT ranged from 47% to 100% with anticoagulation alone. 110,178,[192][193][194] Unfortunately, most studies reporting partial or complete recanalization at 3 to 6 months have a small sample size. When 4 studies that included 114 CVT patients were combined, partial or complete recanalization at 3 to 6 months was observed in 94 (82.5%).…”

“…When 4 studies that included 114 CVT patients were combined, partial or complete recanalization at 3 to 6 months was observed in 94 (82.5%). 110,178,192,193 Recanalization rates may be higher for patients who receive thrombolytic therapy. 14 In general, thrombolytic therapy is used if clinical deterioration continues despite anticoagulation or if a patient has elevated intracranial pressure that evolves despite other management approaches.…”

“…Mechanical manipulation of the thrombus with the guidewire increases the amount of clot that might be impacted by the thrombolytic agent, potentially reducing the amount of fibrinolytic agent used. 61,113,131,150,170,188,192,[195][196][197][198][199][200][201][202][203][204][205] In a retrospective multicenter study of CVT in the United States, 27 (15%) of 182 patients received endovascular thrombolysis. Ten patients were receiving concomitant anticoagulation therapy.…”

Cerebral venous sinus thrombosis: review of the demographics, pathophysiology, current diagnosis, and treatment

“…In the past, CVST had been associated with a dismal prognosis and high mortality rate, reaching 30-50%. 5,54 Recent studies, 6,32,37,64,65,68 and especially the ISCVT study, performed in the era of modern neuroimaging, LMWH administration, and endovascular intervention, reported much lower mortality rates (8-14%) and significantly better outcome. A meta-analysis of 19 studies conducted by Dentali et al 22 showed that the mortality rate during the perihospitalization period was about 5.6%, while at the end of the follow-up period, this percentage increased to 9.4%.…”