Safety and efficacy of endovascular thrombectomy in patients with severe cerebral venous thrombosis: A meta-analysis

Abstract

Background Cerebral venous thrombosis (CVT) is a rare thrombotic condition which is traditionally treated with anti-coagulation therapy. Subsets of patients with severe CVT have been treated with endovascular thrombectomy (EVT). Despite the high estimated mortality associated with severe CVT, there has been only one randomized control trial done regarding safety and efficacy of EVT in severe CVT compared to standard medical management. Evidence in this area is lacking. Objective The aim of this systematic review is to analyze all existing literature and generate robust information regarding the role of EVT in the management of patients with severe CVT. Methods This systematic review and meta-analysis followed PRISMA guideline. PubMed, Embase, Google Scholar, and CNKI were searched for eligible studies from 2007 to 2021. Safety and efficacy of EVT were evaluated by meta-analyzing recanalization status, the good functional outcome at follow-up, recurrent CVT, new hematoma. A pooled proportion with a 95% confidence interval was derived from a meta-analysis of various outcomes (CI). Results A total of 33 studies comprising 610 patients treated with EVT were included for analysis which comprised one randomized control trial, one prospective study and 31 retrospective studies. Based on pooled data, 85% of patients had good functional outcome, 62% had complete recanalization, 5% had all-cause mortality, and 3% had catheter related complications. The efficacy outcomes in this analysis had a significant heterogeneity and a subgroup analysis was also done to explain these findings. The minimum time of follow up was 3 months and varied EVT techniques were used across the studies. Conclusion This meta-analysis suggests EVT may be safe and efficacious in treating patients with severe CVT. Registration Our protocol was registered with PROSPERO: International prospective register of systematic reviews with the registration number CRD42021254760.

Successful hybrid endovascular treatment for refractory cerebral venous sinus thrombosis in pregnancy: A case report

“…Given the small sample size of this study, although no conclusion was reached that EVT was superior to standard medical treatment, after careful screening and strategy improvement, it could be confirmed that some patients might still benefit from endovascular in future studies. A recent meta-analysis suggested endovascular treatment may be safe and efficacious in treating patients with severe CVST [ 13 ]. More studies with large sample sizes are needed to provide reliable data on the efficacy and safety of endovascular treatment for CVST.…”

Factors related to cerebral venous sinus thrombosis: A cross-sectional study

“…Endovascular thrombolysis or mechanical thrombectomy has been limited to case reports or case series studies, so the advantage of heparin anticoagulant therapy in nonsevere CVST patients cannot be evaluated [43]. However, in a patient cohort that included patients that were prone to poor prognosis, EVT might be a reasonable therapeutic option [44,45]. According to the clinical guidelines [1] and our experience in single-center diagnosis and treatment, endovascular intervention can be used in selected patients with severe CVST (excluding large intracerebral hematoma), such as consciousness disturbance, malignant intracranial pressure increase (lumbar puncture intracranial pressure > 350 mmH2O) or progressive vision loss.…”

Nationwide Study on Clinical Outcomes of Endovascular Interventions for Cerebral Venous Thrombosis in Japan

“…Despite contradictory results regarding the benefits of endovascular treatments, no explicit complications were observed. As the safety of endovascular therapy has been repeatedly reported, 11,21 treatment abandonment may be premature. Hence, more detailed research is required to reach definitive conclusions.…”