Evaluating the efficacy of stent retriever and catheter aspiration combination in refractory cerebral venous sinus Thrombosis: A comprehensive Meta-Analysis

Abstract

Background: Cerebral Venous Sinus Thrombosis (CVST) is a rare but potentially life-threatening condition, often associated with specific risk factors. The primary treatment for CVST is anticoagulation, but some cases progress to Refractory CVST (rCVST), requiring endovascular treatment. A combination of stent retriever and catheter aspiration is emerging as a promising technique to enhance treatment effectiveness. We conducted a systematic review and meta-analysis to assess the safety and efficacy of this approach, aiming to improve recanalization success and neurological outcomes while reducing complications in rCVST patients.

Methods: A search following PRISMA guidelines was conducted across Pubmed, Embase, Web of Science, and Cochrane databases to identify studies on the use of stent retrievers and catheter aspiration for rCVST. Pooled analysis with 95 % confidence intervals was used to assess the effects. Heterogeneity was evaluated using I² statistics and a random-effects model was used. Complete recanalization. good clinical outcomes (mRS ≤ 2), hemorrhagic, neurological, ischemic, and total complications, poor clinical outcomes (mRS > 2), and mortality were assessed.

Results: A meta-analysis of five retrospective studies involving 55 patients examined outcomes in CVST. The median mean age was 40 years. Complete recanalization rate: 36 % (95 % CI: 9 % to 62 %, I² = 90 %). Good clinical outcomes: 72 % (95 % CI: 50 % to 94 %, I² = 76 %). Hemorrhagic complications: 2 % (95 % CI: 0 % to 8 %, I² = 15 %). Ischemic complications: 0 % (95 % CI: 0 % to 6 %, I² = 0 %). Neurological complications: 7 % (95 % CI: 0 % to 14 %, I² = 0 %). Poor clinical outcomes: 26 % (95 % CI: 6 % to 46 %, I² = 70 %). Total complications: 6 % (95 % CI: 0 % to 15 %, I² = 10 %). Mortality rate: 5 % (95 % CI: 0 % to 13 %, I² = 19 %).

Conclusion: This systematic review and meta-analysis scrutinized the efficacy of combining Stent Retriever and Catheter Aspiration for rCVST. Findings highlighted varied outcomes, including recanalization rates, complications, and mortality. The dichotomy between good and poor outcomes underscores the necessity for personalized therapeutic decisions. While offering a comprehensive overview, the study emphasizes literature heterogeneity, suggesting a need for more rigorous and standardized research to optimize therapeutic strategies in clinical practice.

Keywords: Catheter aspiration; Cerebral venous sinus thrombosis; Refractory cerebral venous sinus thrombosis; Stent retriever.