Is there a role for endovascular treatment in cerebral sinus thrombosis?
Cerebral venous sinus thrombosis (CVT) accounts for 0.5% of all stroke cases and is a relatively uncommon cause of cerebral hemorrhage and edema. Due to the rarity of the disease and the overall outcome that is more favorable than for ischemic stroke or spontaneous ICH, evidence still lacks for the efficacy of endovascular treatment in cerebral sinus thrombosis. Different techniques have been described, but endovascular treatment (EVT) practice varies widely between centers. Some allegedly report as many as 20 cases annually, while other high-volume centers perform less than 1. This is a quick review of the literature focusing on currently available results for EVT in CVT and potential selection criteria for individualized treatment decisions.
Experts-recommendations for patient selection for EVT in CVT:
There is still reasonable debate about the benefit of EVT in CVT patients. Currently, available experience with endovascular treatments suggests that it should be reserved for selected patients, and most importantly, the treatment decision should not wait for the initial outcome of anticoagulation therapy. The main scope of the treatment may be to create a channel inside the thrombosed sinus, to establish flow, and to augment the effects of local endogenous tPA and systemic anticoagulation.
1. Coutinho JM, Zuurbier SM, Bousser MG, Ji X, Canhão P, Roos YB, et al. Effect of Endovascular Treatment With Medical Management vs Standard Care on Severe Cerebral Venous Thrombosis: The TO-ACT Randomized Clinical Trial. JAMA Neurol. 2020 Aug 1;77(8):966–73.
2. Siegler JE, Shu L, Yaghi S, Salehi Omran S, Elnazeir M, Bakradze E, et al. Endovascular Therapy for Cerebral Vein Thrombosis: A Propensity-Matched Analysis of Anticoagulation in the Treatment of Cerebral Venous Thrombosis. Neurosurgery. 2022;91(5).
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