Related Experiment Video
Updated: May 5, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Mechanical Thrombectomy for Aseptic, Atraumatic, Medically Refractory Cerebral Venous Sinus Thrombosis: a Systematic
1Department of Internal Medicine, UPMC Aut Even Hospital, Freshford Road, R95D370, Kilkenny, Ireland. quealyj@upmc.ie.
Insights
Endovascular therapy (EVT) for cerebral venous sinus thrombosis (CVST) shows improved outcomes with complete recanalization. Clot maceration and stent-retriever thrombectomy are superior EVT methods for better clinical efficacy and safety.
Area of Science:
- Neurology
- Interventional Radiology
- Vascular Medicine
Background:
- Cerebral venous sinus thrombosis (CVST) can lead to severe clinical outcomes in 13.5% of cases.
- Current guidelines recommend endovascular therapy (EVT) for CVST, but no randomized controlled trials compare different EVT methods.
- This study addresses the lack of comparative data on EVT efficacy and safety in CVST.
Purpose of the Study:
- To compare the efficacy and safety of various endovascular therapies (EVTs) for cerebral venous sinus thrombosis (CVST).
- To identify predictors of clinical and technical success in EVT for CVST.
Main Methods:
- A systematic review of multiple databases (CENTRAL, Medline, Embase) and clinical trial registers was conducted.
- Studies included all cases of CVST treated with mechanical thrombectomy (MT), excluding pediatric and trauma/infection-related cases.
- Outcomes assessed included clinical efficacy (modified Rankin Score), technical efficacy (recanalisation), and safety (complications, death), with subgroup analyses performed.
Main Results:
- The review included 124 papers with 486 patients undergoing MT, 69.5% receiving chemolysis.
- Predictors of poor efficacy included age ≥55, altered mental status, and low Glasgow Coma Scale score.
- Complete recanalisation correlated with improved clinical efficacy and safety outcomes. Clot maceration and stent-retriever thrombectomy demonstrated superior outcomes compared to balloon angioplasty and rheolysis.
Conclusions:
- The review's findings are limited by the high risk of bias inherent in case reports and series.
- Predictors of poor outcomes in medical therapy also predict poor outcomes with MT; these should not limit candidacy.
- Complete recanalisation is key for favorable outcomes; local chemolysis is safe and recommended. Clot maceration and stent-retriever thrombectomy offer superior efficacy and safety.
Background:
Cerebral venous sinus thrombosis (CVST) follows a severe clinical course in 13.5% of cases. Practice guidelines recommend endovascular therapy (EVT); no randomised control trials (RCTs) exist comparing EVTs.
Purpose:
To determine whether specific EVTs are superior to alternatives.
Data Sources:
CENTRAL, Medline, Embase, five other databases and four clinical trials registers. Grey literature searches, reference checking, citation searching, and author contact.
Study Selection:
All CVST cases treated with mechanical thrombectomy (MT) were includible. Paediatric, and trauma-related or infection-related thromboses were excluded.
Data Analysis:
Standard Cochrane review procedures. Primary outcome measures; clinical efficacy (modified Rankin Score, mRS), technical efficacy (recanalisation), and clinical safety (procedure-related complications and death). Subgroup analyses were performed, comparing outcome measures between demographic groups, clinico-radiological severity, interventional strategies, and degrees of recanalisation.
Data Synthesis:
In this study 124 papers were included (n = 486). All patients underwent MT, with 69.5% of patients receiving concomitant chemolysis. New/expanding intracerebral haemorrhage (ICH) occurred in 5.1%; non-haemorrhagic complications in 1.4%; 10.7% died. Predictors of poor efficacy included age ≥ 55 years, altered mental status (AMS), Glasgow Coma Scale (GCS) < 8. Predictive of poor safety outcomes included pre-existing ICH, deep system thrombosis, and AMS. Complete recanalisation was associated with improved clinical efficacy and safety outcomes.
Limitations:
The review is based on case reports/series, increasing bias-risk. Myriad of potentially includible studies were necessarily excluded due to lack of requisite details.
Conclusion:
Predictors of poor outcomes with medical therapy predict poor outcomes with MT; these measures should not dictate candidacy. Complete recanalisation predicts favorable clinical and safety outcomes. Local chemolysis is safe, improves recanalisation, and should be recommended, provided there is no contraindication. Clot maceration strategies and stent-retriever thrombectomy are associated with superior clinical efficacy and safety endpoints, as compared with balloon angioplasty and rheolysis.
Related Concept Videos
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
01:29Venous Thrombosis III: Interprofessional Care