Mechanical thrombectomy versus intrasinus thrombolysis for cerebral venous sinus thrombosis: A non-randomized comparison

Fazeel M. Siddiqui, Chirantan Banerjee, Susanna M. Zuurbier, Qing Hao, Chul Ahn, Glenn L. Pride, Muhammad Wasay, Charles B L M Majoie, David Liebeskind, Mark Johnson, Jan Stam

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

Small retrospective studies have shown the benefit of endovascular treatment with intrasinus thrombolysis (IST) or mechanical thrombectomy (MT) with/without IST (MT+/-IST) in cases of multifocal cerebral venous thrombosis (CVT). Our study compares the mortality, functional outcome and periprocedural complications among patients treated with MT +/- IST versus IST alone. We reviewed clinical and angiographic findings of 63 patients with CVT who received endovascular treatment at three tertiary care centers. Primary outcome variables were discharge mortality and neurological dysfunction, and intermediate (three months) and long-term (>six months) morbidity. The modified Rankin scale (mRS) was used to assess morbidity. mRS ≤1 was considered a good recovery. Neurological dysfunction was rated as neuroscore: 0, normal; 1, mild (ambulatory, communicative); 2, moderate (non-ambulatory, communicative); and 3, severe (non-ambulatory, non-communicative/comatose). In patients who received IST alone, presenting neurological deficits were comparatively minor (p<0.001). When the two groups were adjusted for admission neuroscore, there was no statistical significance between discharge mortality [7(21%) versus 4(14%), p=0.228], neurological dysfunction (p=0.442), intermediate (p=0.336) and long-term morbidity (p=0.988). Patients who received MT +/- IST had a higher percentage of periprocedural complications without reaching statistical significance. Compared to IST, MT was performed in severe cases with extensive sinus involvement. When adjusted for admission neurological dysfunction, both groups had similar mortality and discharge neurological dysfunction and similar intermediate and long-term morbidity.

Original languageEnglish (US)
Pages (from-to)336-344
Number of pages9
JournalInterventional Neuroradiology
Volume20
Issue number3
DOIs
StatePublished - 2014

Keywords

  • Cerebral venous thrombosis
  • Stroke
  • Thrombectomy
  • Thrombolysis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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