Endovascular treatment of cerebral venous sinus thrombosis: A systematic review and meta-analysis of efficacy based on technique.
Diwas Gautam, Omid Shoraka, Sarah Nguyen et al.
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In 30 seconds
This systematic review and meta-analysis assessed clinical and radiographic outcomes after endovascular treatment of cerebral venous sinus thrombosis (CVST). It included 26 studies with 273 patients treated with endovascular thrombectomy or thrombolysis, generally for disease refractory to systemic anticoagulation. Pooled estimates showed complete recanalization in 37% and partial recanalization in 57%; 79% had a good clinical outcome (modified Rankin Scale score 0–2) at last follow-up. Outcomes did not differ significantly between modern and older thrombectomy systems, while aspiration alone was associated with more good outcomes than combined aspiration and stent-retriever treatment.
Key findings
- Pooled estimates showed complete recanalization in 37% and partial recanalization in 57%.
- A good clinical outcome (modified Rankin Scale score 0–2) at last follow-up was estimated in 79% of patients.
- Aspiration alone had more good clinical outcomes than the combined technique (83.8% vs. 61.5%, p = 0.004).
- No statistically significant differences were found between modern systems and older systems in safety or efficacy.
Why it matters
CVST can be life-threatening, and these pooled findings describe outcomes in patients receiving endovascular treatment, including many with preprocedural intracranial hemorrhage. The results provide clinicians with estimates of recanalization and functional outcomes across techniques, while the lack of significant differences between device eras cautions against assuming newer systems are superior.
What to keep in mind
The evidence came from 26 studies rather than a reported randomised comparison, and the abstract does not establish that differences between techniques reflect causal effects.