title: Mechanical thrombectomy versus intrasinus thrombolysis for cerebral venous sinus thrombosis: a non-randomized comparison.
abstract: Small retrospective studies have shown the benefit of endovascular treatment with intrasinus thrombolysis (IST) or mechanical thrombectomy (MT) with/without IST (MT ± IST) in cases of multifocal cerebral venous thrombosis (CVT). Our study compares the mortality, functional outcome and periprocedural complications among patients treated with MT ± IST versus IST alone. We reviewed clinical and angiographic findings of 63 patients with CVT who received endovascular treatment at three tertiary care centers. Primary outcome variables were discharge mortality and neurological dysfunction, and intermediate (three months) and long-term (>six months) morbidity. The modified Rankin scale (mRS) was used to assess morbidity. mRS ≤ 1 was considered a good recovery. Neurological dysfunction was rated as neuroscore: 0, normal; 1, mild (ambulatory, communicative); 2, moderate (non-ambulatory, communicative); and 3, severe (non-ambulatory, non-communicative/comatose). In patients who received IST alone, presenting neurological deficits were comparatively minor (p<0.001). When the two groups were adjusted for admission neuroscore, there was no statistical significance between discharge mortality [7(21%) versus 4(14%), p=0.228], neurological dysfunction (p=0.442), intermediate (p=0.336) and long-term morbidity (p=0.988). Patients who received MT ± IST had a higher percentage of periprocedural complications without reaching statistical significance. Compared to IST, MT was performed in severe cases with extensive sinus involvement. When adjusted for admission neurological dysfunction, both groups had similar mortality and discharge neurological dysfunction and similar intermediate and long-term morbidity.
authors: University of Texas Southwestern Medical Center; Dallas, TX, USA - fazeelmukhtar@gmail.com.
authors: Fazeel M
authors: FM
authors: Siddiqui
authors: University of Texas Southwestern Medical Center; Dallas, TX, USA.
authors: Chirantan
authors: C
authors: Banerjee
authors: Academic Medical Center, University of Amsterdam; Amsterdam, Netherlands.
authors: Susanna M
authors: SM
authors: Zuurbier
authors: University of California Los Angeles; Los Angeles, CA, USA.
authors: Qing
authors: Q
authors: Hao
authors: University of Texas Southwestern Medical Center; Dallas, TX, USA.
authors: Chul
authors: C
authors: Ahn
authors: University of Texas Southwestern Medical Center; Dallas, TX, USA.
authors: Glenn L
authors: GL
authors: Pride
authors: Aga Khan University; Karachi, Pakistan.
authors: Muhammad
authors: M
authors: Wasay
authors: Academic Medical Center, University of Amsterdam; Amsterdam, Netherlands.
authors: Charles Blm
authors: CB
authors: Majoie
authors: University of California Los Angeles; Los Angeles, CA, USA.
authors: David
authors: D
authors: Liebeskind
authors: University of Texas Southwestern Medical Center; Dallas, TX, USA.
authors: Mark
authors: M
authors: Johnson
authors: Academic Medical Center, University of Amsterdam; Amsterdam, Netherlands.
authors: Jan
authors: J
authors: Stam
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007276:Injections, Intraventricular; D008297:Male; D061185:Mechanical Thrombolysis / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D011859:Radiography; D012851:Sinus Thrombosis, Intracranial / Q000000981:diagnostic imaging* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents
keywords: cerebral venous thrombosis; stroke; thrombectomy; thrombolysis