Mechanical Thrombectomy for Aseptic, Atraumatic, Medically Refractory Cerebral Venous Sinus Thrombosis: a Systematic...

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.