Mechanical Thrombectomy in Cerebral Venous Sinus Thrombosis: Reports of a Retrospective Single-Center Study

Abstract

Current standard care for acute cerebral venous sinus thrombosis (CVST) includes either intravenous heparin or subcutaneous low-molecular-weight heparin, but patients with refractory CVST, despite adequate anticoagulation therapy, may benefit from mechanical thrombectomy (MT). A retrospective study of patients with CVST, who underwent MT between 2011 and 2019, was performed looking at procedure success rate and clinical outcomes. Two raters evaluated the cerebral venous system of every patient before and after the intervention using the following scoring system: (0) No obvious thrombosis; (1) thrombosis without impaired blood flow; (2) thrombosis with impaired blood flow; (3) and thrombosis with complete vascular occlusion. The success of MT was measured using a score quotient (Q = A/B), dividing the sum of the patient's scores after the intervention (A) by the sum of scores before the intervention (B). Overall, 21 MTs were performed on 20 patients with refractory or severe CVST. Clinical improvement was seen in 61.9% during hospital stay and in 80% at 6-month follow-up, with complete recovery in 70% of patients. Patients with favorable outcomes had significantly lower recanalization quotients (p = 0.008). Our study provides evidence supporting that MT may be a safe and effective treatment with favorable clinical outcomes for selected patients with CVST.

Keywords: cerebral venous sinus thrombosis; endovascular therapy; mechanical thrombectomy; thrombolysis.

Figure 1

Cerebral venous system divided into 10 anatomical regions.

Figure 2

A child with a history of acute lymphocytic leukemia (ALL) presented with altered mental status. (a) Preprocedure lateral left internal carotid artery angiogram demonstrates thrombosis of superior sagittal sinus and left transvers sinus; (b) Postprocedure lateral left internal carotid artery angiogram after treatment with Solitaire Revascularization Device demonstrate patency of the superior sagittal sinus and left transverse sinus with satisfactory flow (Q = 0.57).

Figure 3

Boxplot of recanalization quotient (0 = complete recanalization, 1 = no recanalization) in procedures with bad outcome (worsening of mRS) and good outcome (improvement of mRS).