Mechanical Thrombectomy for Treatment of Cerebral Venous Sinus Thrombosis in Vaccine-Induced Immune Thrombotic Thrombocytopenia

Abstract

Reports of a rare form of cerebral venous sinus thrombosis with profound thrombocytopenia have emerged following introduction of the adenovirus-vectored coronavirus disease 2019 (COVID-19) vaccines. Between March and June 2021, seven cases of refractory vaccine-induced immune thrombotic thrombocytopenia were referred to our institution for mechanical thrombectomy. The condition of 1 patient deteriorated during interhospital transfer, and the remaining 6 underwent successful recanalization. No procedure-related adverse events were reported. At the time of this writing, 3 patients have been discharged with a good functional outcome (mRS 0-1), one required rehabilitation for mild dysarthria and vocal cord palsy (mRS 3), and 2 have died due to severe mass effect. Our anecdotal experience suggests that endovascular therapy may be safe and effective in reducing thrombus burden in selected cases of postvaccination cerebral venous sinus thrombosis.ABBREVIATIONS: COVID-19 ¼ coronavirus disease 2019; CVST ¼ cerebral venous sinus thrombosis; HIT ¼ heparin-induced thrombocytopenia; ICH ¼ intracerebral hemorrhage; PF ¼ platelet factor; VITT ¼ vaccine-induced immune thrombotic thrombocytopenia

Endovascular Treatment of Intracranial Vein and Venous Sinus Thrombosis—A Systematic Review

“…Of those, 14 records were excluded (because of lack of reported patient data, review articles and registry data without information on individual patients). Eleven records were eligible for analysis ( Table 2 ) [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ], comprising case reports and case series only. Of those, four case reports and case series presented data for four patients with COVID-19 and EVT [ 61 , 62 , 63 , 64 ].…”

“…The first reports of SVT caused by VITT emerged in 2021 [ 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. As of 20 May 2022, seven records of EVT in 16 VITT patients were identified [ 65 , 66 , 67 , 68 , 69 , 70 , 71 ].…”

“…The first reports of SVT caused by VITT emerged in 2021 [ 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. As of 20 May 2022, seven records of EVT in 16 VITT patients were identified [ 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. Most cases ( n = 15) were attributed to the ChAdOx1 nCoV-19 (AstraZeneca, Cambridge, UK) vaccine [ 65 , 66 , 67 , 69 , 70 , 71 ].…”

“…As of 20 May 2022, seven records of EVT in 16 VITT patients were identified [ 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. Most cases ( n = 15) were attributed to the ChAdOx1 nCoV-19 (AstraZeneca, Cambridge, UK) vaccine [ 65 , 66 , 67 , 69 , 70 , 71 ]. Only one case appeared to be associated with an mRNA vaccine (mRNA-1273 vaccine; Moderna, Cambridge, MA, USA) [ 68 ].…”

“…Neurological deterioration potentially resulting in poor outcomes facilitated the use of EVT. The technical strategies described were aspiration plus stent retriever or balloon-guided thrombectomy in selected cases [ 65 , 66 , 67 , 69 ]. MRS of 0–1 was observed in seven patients during follow-up [ 65 , 66 , 69 ].…”