Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis: A systematic review

Adeel Ilyas, Ching Jen Chen, Daniel M. Raper, Dale Ding, Thomas Buell, Panogiotis Mastorakos, Kenneth Liu

Research output: Contribution to journalReview article

34 Citations (Scopus)

Abstract

Background Cerebral venous sinus thrombosis (CVST) is an uncommon form of stroke that, when severe, can be a therapeutic challenge. Endovascular mechanical thrombectomy (EMT) techniques have significantly evolved over the past decade, but data regarding the efficacy and safety of EMT for CVST are poorly defined. Objective To summarize the large number of case series on this relatively rare condition and establish trends in the outcomes of EMT for CVST. Methods A literature review was performed using PubMed and Medline to identify reports of three or more patients with CVST treated with EMT. Baseline and outcomes data, including radiographic resolution, neurological outcome, recurrence, and treatment-related complications, were extracted for analysis. Results A total of 17 studies comprising 235 patients treated with EMT were included for analysis. Based on pooled data, 40.2% of patients presented with encephalopathy or coma. Concurrent endovascular thrombolysis was employed in 87.6% of patients. Complete radiographic resolution of CVST was achieved in 69.0% of patients. At follow-up (range 0.5-3.5 €...years), 34.7% of patients were neurologically intact and the mortality rate was 14.3%. CVST recurrence was evident in 1.2%. Worsening or new intracranial hemorrhage (ICH) occurred in 8.7% of cases. ORs of good outcome (modified Rankin Scale score 0-2) and development of ICH with sole EMT versus concurrent thrombolytic therapy were 1.51 (95% CI 0.29 to 8.15, p=0.61) and 1.15 (95% CI 0.12 to 10.80, p=0.90), respectively. Conclusions EMT is an effective salvage therapy for refractory CVST, with a reasonable safety profile. Chemical thrombolysis, in conjunction with EMT, did not appear to result in additional harm or benefit. Further analysis is warranted to determine predictors of success after EMT for CVST.

Original languageEnglish (US)
Pages (from-to)1086-1092
Number of pages7
JournalJournal of neurointerventional surgery
Volume9
Issue number11
DOIs
StatePublished - Nov 1 2017

Fingerprint

Intracranial Sinus Thrombosis
Thrombectomy
Venous Thrombosis
Intracranial Hemorrhages
Safety
Recurrence
Salvage Therapy
Thrombolytic Therapy
Brain Diseases
Coma
PubMed
Stroke

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Ilyas, Adeel ; Chen, Ching Jen ; Raper, Daniel M. ; Ding, Dale ; Buell, Thomas ; Mastorakos, Panogiotis ; Liu, Kenneth. / Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis : A systematic review. In: Journal of neurointerventional surgery. 2017 ; Vol. 9, No. 11. pp. 1086-1092.
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title = "Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis: A systematic review",
abstract = "Background Cerebral venous sinus thrombosis (CVST) is an uncommon form of stroke that, when severe, can be a therapeutic challenge. Endovascular mechanical thrombectomy (EMT) techniques have significantly evolved over the past decade, but data regarding the efficacy and safety of EMT for CVST are poorly defined. Objective To summarize the large number of case series on this relatively rare condition and establish trends in the outcomes of EMT for CVST. Methods A literature review was performed using PubMed and Medline to identify reports of three or more patients with CVST treated with EMT. Baseline and outcomes data, including radiographic resolution, neurological outcome, recurrence, and treatment-related complications, were extracted for analysis. Results A total of 17 studies comprising 235 patients treated with EMT were included for analysis. Based on pooled data, 40.2{\%} of patients presented with encephalopathy or coma. Concurrent endovascular thrombolysis was employed in 87.6{\%} of patients. Complete radiographic resolution of CVST was achieved in 69.0{\%} of patients. At follow-up (range 0.5-3.5 €...years), 34.7{\%} of patients were neurologically intact and the mortality rate was 14.3{\%}. CVST recurrence was evident in 1.2{\%}. Worsening or new intracranial hemorrhage (ICH) occurred in 8.7{\%} of cases. ORs of good outcome (modified Rankin Scale score 0-2) and development of ICH with sole EMT versus concurrent thrombolytic therapy were 1.51 (95{\%} CI 0.29 to 8.15, p=0.61) and 1.15 (95{\%} CI 0.12 to 10.80, p=0.90), respectively. Conclusions EMT is an effective salvage therapy for refractory CVST, with a reasonable safety profile. Chemical thrombolysis, in conjunction with EMT, did not appear to result in additional harm or benefit. Further analysis is warranted to determine predictors of success after EMT for CVST.",
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Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis : A systematic review. / Ilyas, Adeel; Chen, Ching Jen; Raper, Daniel M.; Ding, Dale; Buell, Thomas; Mastorakos, Panogiotis; Liu, Kenneth.

In: Journal of neurointerventional surgery, Vol. 9, No. 11, 01.11.2017, p. 1086-1092.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis

T2 - A systematic review

AU - Ilyas, Adeel

AU - Chen, Ching Jen

AU - Raper, Daniel M.

AU - Ding, Dale

AU - Buell, Thomas

AU - Mastorakos, Panogiotis

AU - Liu, Kenneth

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background Cerebral venous sinus thrombosis (CVST) is an uncommon form of stroke that, when severe, can be a therapeutic challenge. Endovascular mechanical thrombectomy (EMT) techniques have significantly evolved over the past decade, but data regarding the efficacy and safety of EMT for CVST are poorly defined. Objective To summarize the large number of case series on this relatively rare condition and establish trends in the outcomes of EMT for CVST. Methods A literature review was performed using PubMed and Medline to identify reports of three or more patients with CVST treated with EMT. Baseline and outcomes data, including radiographic resolution, neurological outcome, recurrence, and treatment-related complications, were extracted for analysis. Results A total of 17 studies comprising 235 patients treated with EMT were included for analysis. Based on pooled data, 40.2% of patients presented with encephalopathy or coma. Concurrent endovascular thrombolysis was employed in 87.6% of patients. Complete radiographic resolution of CVST was achieved in 69.0% of patients. At follow-up (range 0.5-3.5 €...years), 34.7% of patients were neurologically intact and the mortality rate was 14.3%. CVST recurrence was evident in 1.2%. Worsening or new intracranial hemorrhage (ICH) occurred in 8.7% of cases. ORs of good outcome (modified Rankin Scale score 0-2) and development of ICH with sole EMT versus concurrent thrombolytic therapy were 1.51 (95% CI 0.29 to 8.15, p=0.61) and 1.15 (95% CI 0.12 to 10.80, p=0.90), respectively. Conclusions EMT is an effective salvage therapy for refractory CVST, with a reasonable safety profile. Chemical thrombolysis, in conjunction with EMT, did not appear to result in additional harm or benefit. Further analysis is warranted to determine predictors of success after EMT for CVST.

AB - Background Cerebral venous sinus thrombosis (CVST) is an uncommon form of stroke that, when severe, can be a therapeutic challenge. Endovascular mechanical thrombectomy (EMT) techniques have significantly evolved over the past decade, but data regarding the efficacy and safety of EMT for CVST are poorly defined. Objective To summarize the large number of case series on this relatively rare condition and establish trends in the outcomes of EMT for CVST. Methods A literature review was performed using PubMed and Medline to identify reports of three or more patients with CVST treated with EMT. Baseline and outcomes data, including radiographic resolution, neurological outcome, recurrence, and treatment-related complications, were extracted for analysis. Results A total of 17 studies comprising 235 patients treated with EMT were included for analysis. Based on pooled data, 40.2% of patients presented with encephalopathy or coma. Concurrent endovascular thrombolysis was employed in 87.6% of patients. Complete radiographic resolution of CVST was achieved in 69.0% of patients. At follow-up (range 0.5-3.5 €...years), 34.7% of patients were neurologically intact and the mortality rate was 14.3%. CVST recurrence was evident in 1.2%. Worsening or new intracranial hemorrhage (ICH) occurred in 8.7% of cases. ORs of good outcome (modified Rankin Scale score 0-2) and development of ICH with sole EMT versus concurrent thrombolytic therapy were 1.51 (95% CI 0.29 to 8.15, p=0.61) and 1.15 (95% CI 0.12 to 10.80, p=0.90), respectively. Conclusions EMT is an effective salvage therapy for refractory CVST, with a reasonable safety profile. Chemical thrombolysis, in conjunction with EMT, did not appear to result in additional harm or benefit. Further analysis is warranted to determine predictors of success after EMT for CVST.

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U2 - 10.1136/neurintsurg-2016-012938

DO - 10.1136/neurintsurg-2016-012938

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