1241. Thrombectomy for Cerebral Venous Sinus Thrombosis

Authors: Jason Hsieh, MD; Mark Bain, MD (Cleveland, OH)

Introduction:

Patients with cerebral venous sinus thrombosis (CVST) often suffer from prolonged cerebral venous hypertension resulting in refractory ICP elevation, intracranial hemorrhage, morbidity, or death.  Thrombectomy offers the possibility of immediate relief of thrombotic cerebral venous hypertension but is not commonly performed.  We reviewed our institutional experience with endovascular thrombectomy for CVST.

Methods:

We performed a database query using broadly inclusive diagnosis and procedural codes for CVST and endovascular therapy, and chart review was performed.

Results:

We identified 47 patients of which 11 were eligible for inclusion.  Patients were a mean age of 35.4 years (range 17-58) and 9 were female.  Average GCS was 13 (range 4-15) with symptoms ranging from headache to obtundation and decerebrate posturing.  All cases involved multiple sinuses; most involved the superior sagittal sinus (n=9), and right (n=7) and left transverse (n=8) sinuses.  Less commonly, thrombosis involved the right (n=4) and left sigmoid (n=4) sinuses, as well as the straight sinus (n=3).

Endovascular intervention was performed using a variety of devices including the Angiojet (n=10), Penumbra system (n=3), Viatrac balloon (n=1), and Solitaire retriever (n=1).  In five cases a microcatheter was left in place for tPA infusion and in one case thrombectomy was unsuccessful due to difficulty gaining access to the occluded vessels.

No procedural complications were encountered.  Four patients died in-hospital an average of 13 days after presentation.  Four patients at last follow-up had an mRS score of 0 or 1, two had mRS 2, and one had mRS 4.

Conclusion:

Thrombectomy for CVST was technically successful and safe.  However, many patients suffer from poor outcomes, likely related to selection bias and the severity of their disease.  Further study is indicated to determine the relative benefit of thrombectomy compared to medical treatment of CVST.