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. 2024 Oct;30(5):746-758.
doi: 10.1177/15910199221143418. Epub 2022 Dec 5.

Safety and efficacy of endovascular thrombolysis in patients with acute cerebral venous sinus thrombosis: A systematic review

Sepideh Paybast  1 , Reza Mohamadian  2 , Ali Emami  3 , Melika Jameie  1 , Fereshteh Shahrab  4 , Farideh Zamani  4 , Ehsan Sharifipour  1   4
Affiliations

Safety and efficacy of endovascular thrombolysis in patients with acute cerebral venous sinus thrombosis: A systematic review

Sepideh Paybast et al. Interv Neuroradiol. 2024 Oct.

Abstract

Introduction: Cerebral venous sinus thrombosis (CVST) is an uncommon but fatal cause of stroke worldwide. Endovascular treatments could be life-saving in patients who don't treat with anticoagulants as a mainstay of treatment. Currently, there is no consensus considering the safety, efficacy, and also selected approaches of endovascular intervention for these patients. This systematic review evaluates the literature on endovascular thrombolysis (EVT) in CVST patients.

Materials and methods: A comprehensive search was conducted through PubMed and Scopus databases between 2010 and 2021, with additional sources identified through cross-referencing. The primary outcomes were the safety and efficacy of EVT in CVST, including catheter-related and non-catheter-related complications, clinical outcomes, and radiological outcomes.

Results: A total of 10 studies comprising 339 patients were included. Most of the patients presented with headaches (86.72%) and/or focal neurologic deficits (45.43%) (modified Rankin Scale of 5 in 55.88%). Acquired coagulopathy and/or consuming estrogen/progesterone medication were the most frequent predisposing factors (45.59%). At presentation, 68.84% had multi-sinus involvement, and 28.90% had venous infarcts and/or intracranial hemorrhage (ICH). The overall complication rate was 10.3%, with a 2.94%, 1.47%, and 1.17% rate of ICH, herniation, and intracranial edema, respectively. The complete and partial postoperative radiographic resolution was reported in 89.97% of patients, increasing to 95.21% during the follow-up. Additionally, 72.22% of patients had no or mild neurologic deficit at discharge, rising to 91.18% at the last follow-up. The overall mortality rate was 7.07%.

Conclusions: EVT can be an effective and safe treatment option for patients with refractory CVST or contraindications to systemic anticoagulation.

Keywords: CVST; cerebral venous sinus thrombosis; cerebral venous thrombosis; endovascular thrombolysis; endovascular treatments; intracranial”; mechanical thrombolysis; venous stroke; “Sinus thrombosis.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram depicting the selection process for the studies included in the analyses of endovascular thrombolysis for cerebral venous sinus thrombosis according to the Preferred Reporting Items for Systematic Reviews (PRISMA) flow diagram; CVST: cerebral venous sinus thrombosis; DVT: deep vein thrombosis; ET: endovascular thrombolysis; MT: mechanical thrombectomy.
Figure 2.
Figure 2.
The main values of the patients with cerebral venous sinus thrombosis. ICH: Intracranial hemorrhage.
See this image and copyright information in PMC

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