We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Endovascular Treatment for Cerebral Venous Sinus Thrombosis: Comparison among Different Endovascular Procedures.
- Authors
S., Anush Rangarajan; Ramachandran, Dileep; Mishra, Tanaya; Gunaseelan, Vikneshwaran; Dash, Gopal K.; Philip, Vivek J.; Manohar, Radhika; Shetty, Kuldeep; Thomas, Pavin; Huded, Vikram
- Abstract
Background: Cerebral venous sinus thrombosis (CVST) is a rare, treatable cause of stroke. Even though CVST has an established medical treatment, 15% of patients remain refractory to treatment. These patients may be candidates for endovascular treatment (EVT), yet the selection of patients remains a challenge. The study aims to understand the profile and outcome of patients treated with EVT and the type of procedure associated with good outcomes. Methods: This is a single-center, retrospective analysis of CVST patients who underwent EVT from 2009 till 2022. Patients who received only medical management were excluded. Modified Rankin Scale (mRS) ≤2 at 3 months was taken as the primary outcome. Secondary outcomes assessed were hospital stay, death, recurrence, mRS ≤ 2 at discharge, and angiographic recanalization. Results: Fifty-two patients were included. Twenty-eight (53.8%) were males; the mean age was 33.3 ± 12.3 years. Headache (n = 44, 84.6%) predominated among the symptoms. The common risk factors were anemia (n = 13, 25.5%) and hyperhomocysteinemia (n = 13, 25.5%). Worsening of sensorium (n = 21, 40.3%) and non-improvement of symptoms (n = 15, 28.8%) were the common indications for the procedure. Twenty-five (48.1%) people underwent in situ thrombolysis (IST). Death occurred in eight (15.3%) patients. Thirty-six (73.5%; 36/49) patients had a good outcome at 3 months. IST had a significantly better outcome (mRS ≤ 2, n = 20, 80%) compared to other procedures (P = 0.04). Hospital stay was lesser in the IST subgroup, but without statistical significance. Midline shift >5 mm (odds ratio [OR] 6.8 [1.5--30.9], P = 0.01) and Glasgow Coma Scale <9 before the procedure (OR 27.2 [3.1--236.4], P = 0.002) predicted bad outcomes at 3 months. Female gender (OR 4.5 [1.07--8.8], P = 0.03), presence of altered sensorium (OR 10.2 [1.2--87.5], P = 0.01), encephalopathic syndrome (P = 0.02), presence of parenchymal bleed (OR 3.7 [0.9--4.5], P = 0.04), and midline shift (OR 4.8 [1.1--20.2], P = 0.03) were associated with poor outcome at discharge. Conclusion: EVT yielded good outcomes in carefully selected, medically refractory patients of CVST. IST performed well compared to other procedures.
- Subjects
MORTALITY risk factors; CEREBRAL angiography; ANEMIA; THROMBOLYTIC therapy; HEADACHE; HYPERHOMOCYSTEINEMIA; SEX distribution; ENDOVASCULAR surgery; TREATMENT effectiveness; RETROSPECTIVE studies; DISCHARGE planning; DESCRIPTIVE statistics; GLASGOW Coma Scale; SINUS thrombosis; SURGICAL complications; ODDS ratio; LENGTH of stay in hospitals; DISEASE relapse; DISEASE risk factors
- Publication
Annals of Indian Academy of Neurology, 2024, Vol 27, Issue 2, p140
- ISSN
0972-2327
- Publication type
Article
- DOI
10.4103/aian.aian_965_23