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Transvenous Endovascular Recanalization for Cerebral Venous Thrombosis: A Systematic Review and Meta-Analysis
Whitfield Lewis1, Hamidreza Saber2, Mahsa Sadeghi1
1Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA.
Insights
Endovascular treatments for cerebral venous thrombosis offer alternatives when anticoagulation fails. Combined approaches showed a trend toward better outcomes, but further research is needed for optimal patient selection.
Area of Science:
- Neuroendovascular interventions
- Cerebrovascular diseases
- Medical data analysis
Background:
- Systemic anticoagulation therapy is the primary treatment for cerebral venous thrombosis (CVT).
- Emergent recanalization may be necessary for patients who do not respond to anticoagulation.
- Endovascular approaches offer potential therapeutic options for emergent CVT management.
Purpose of the Study:
- To systematically review and meta-analyze the clinical outcomes of various endovascular treatment modalities for CVT.
- To compare the efficacy and safety of transvenous local chemolysis, mechanical thrombectomy, and combined approaches.
- To identify optimal endovascular strategies for patients with CVT who have failed systemic anticoagulation.
Main Methods:
- A comprehensive literature search was conducted in the PubMed database from January 1999 to August 2018.
- Studies reporting endovascular treatment modalities and clinical outcomes (recanalization, functional independence, mortality, intracranial complications) for CVT were included.
- Random-effect models were employed to pool estimates across studies using R software.
Main Results:
- The meta-analysis included 393 patients with CVT from 21 studies.
- Transvenous local chemolysis showed a good outcome rate of 0.88 and complete recanalization rate of 0.59.
- Transvenous mechanical thrombectomy yielded a good outcome rate of 0.66 and complete recanalization rate of 0.60.
- Combined approach treatment demonstrated a good outcome rate of 0.80 and complete recanalization rate of 0.75.
- Mixed approach treatment had the highest mortality rate (0.23) and lowest good outcome rate (0.61).
Conclusions:
- The combined endovascular approach for CVT tended to yield better clinical outcomes compared to other methods.
- While the combined approach showed promise, statistical significance was not achieved for all outcome parameters.
- Further research is warranted to establish the optimal endovascular treatment strategies, tailored to specific clinical and angiographic scenarios in CVT management.
Background:
In patients who have failed systemic anticoagulation therapy, various endovascular approaches may assist in emergent recanalization.
Methods:
We searched the PubMed database from January 1999 to August 2018 for studies that reported endovascular treatment modalities and associated clinical outcomes including recanalization, functional independence, mortality, or intracranial complications. Random-effect models were used to pool estimates across studies using R software.
Results:
Overall, 393 patients with cerebral venous thrombosis from 21 studies were included in the study. Transvenous local chemolysis treatment results were as follows: good outcome rate. 0.88 (95% confidence interval [CI], 0.80-0.93), mortality, 0.08 (95% CI, 0.04-0.16), postprocedural hemorrhagic rate, 0.11 (95% CI, 0.06-0.19), and complete recanalization rate, 0.59 (95% CI, 0.48-0.70). Transvenous mechanical thrombectomy results were as follows: good outcome rate, 0.66 (95% CI, 0.41-0.84), mortality, 0.09 (95% CI, 0.03-0.26), postprocedural hemorrhagic rate, 0.03 (95% CI, 0-0.16), and complete recanalization rate, 0.60 (95% CI, 0.35-0.80). Combined approach treatment results were as follows: good outcome rate, 0.80 (95% CI, 0.70-0.87), mortality, 0.10 (0.04-0.22), postprocedural hemorrhagic rate, 0.17 (95% CI, 0.10-0.27), and complete recanalization rate, 0.75 (95% CI, 0.64-0.84). Mixed approach to treatment results were as follows: good outcome rate, 0.61 (95% CI, 0.51-0.70), mortality, 0.23 (95% CI, 0.16-0.32), postprocedural hemorrhagic rate, 0.46 (95% CI, 0.33-0.59), and complete recanalization rate, 0.48 (95% CI, 0.37-0.58).
Conclusions:
The combination approach treatment tended to have better outcomes, although this meta-analysis did not achieve statistical significance in all outcome parameters. Future studies are needed to establish the best treatment options with tailoring to specific clinical or angiographic scenarios.
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