Predictors of successful endovascular treatment in severe cerebral venous sinus thrombosis

Abstract

Objective The objective of this study was to evaluate the thrombus characteristics affecting the extent of recanalization to identify patients with severe cerebral venous sinus thrombus ( CVT ) more likely to benefit from endovascular therapy. Methods Severe CVT patients scheduled for endovascular treatment were prospectively recruited into the study. Each thrombosed venous segment was evaluated regarding complete or partial recanalization based on digital subtraction angiography ( DSA ) after treatment. Magnetic resonance black‐blood thrombus imaging ( MRBTI ) was performed 1 day before endovascular treatment. The signal‐to‐noise ratio ( SNR ) of the clot, age of the clot, and baseline volume of the clot were compared between the complete and partial recanalization groups. A logistic regression analysis was performed to identify the association between these clot characteristics and recanalization status. Results Twenty‐one CVT patients undergoing endovascular therapy were prospectively included. There were 110 thrombosed segments, 54 of these segments were completely recanalized after endovascular treatment. An acute clot sign ( ACS ) was found in 39 segments and a subacute clot sign ( SCS ) was found in 71 segments. There was no significant difference on baseline volume of the clot (1638.8 ± 1432.2 mm 3 vs. 1957.5 ± 2056.1 mm 3 , P > 0.05) between the complete and partial recanalization groups. Logistic regression analysis showed that ACS on MRBTI was associated with complete recanalization ( P < 0.001, odds ratio = 3.937, 95% confidence interval, 1.6–9.5). Interpretation ACS can be used to predict complete recanalization in patients undergoing endovascular treatment. MRBTI provides a robust method to define clot composition and is potentially useful in selecting the most appropriate CVT patients for endovascular treatment.

High-Resolution Magnetic Resonance Black Blood Thrombus Imaging and Serum D-Dimer in the Confirmation of Acute Cortical Vein Thrombosis

“…DSA is also limited in that it is an invasive test, has a high cost, involves radiation exposure and the use of iodinated contrast, and is contraindicated in patients who are pregnant or have iodine allergies or thyroid disease. HR-MRBTI is not only a qualitative method for evaluating pathological stages of thrombus development, but is also a quantitative way to demonstrate thrombus load ( 13 , 27 ).…”

Comparison Between the Diagnostic Performance of 1.5 T and 3.0 T field Strengths for Detecting Deep Vein Thrombosis Using Magnetic Resonance Black-Blood Thrombus Imaging

“…Based on relevant reports 13,19 and previous studies, [9][10][11] BTI has become an important tool to predict the success of thrombus therapy because changes in the venous thrombus signal can be observed on BTI images. With the rising popularity of MR in major hospitals and the development of MR technology, an increasing number of physicians use MR for preoperative Abbreviations: BTI, black-blood thrombus imaging; CE-MRV, contrast-enhanced MR venography; MR, magnetic resonance.…”

T1-weighted Black-blood Magnetic Resonance Imaging Helps to Stage Thrombus on Segment Level and Predict the Outcome of Endovascular Therapy in Patients with Cerebral Venous Sinus Thrombosis

“…Despite increased advances in recognition of CVST in recent years, accurate and personalized treatment of CVST remains a di cult task in clinical practice because the thrombus composition changes during CVST progress [3]. Recent reports demonstrated that the outcome of endovascular therapy for patients with CVST is associated with the thrombus stage [4][5][6]. Therapeutic schedules for CVST should be based on correct estimation of the thrombus stage [7][8][9].…”