Deep Cerebral Venous Thrombosis Treatment
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REVIEW ARTICLE
Deep Cerebral Venous Thrombosis Treatment Endovascular Case using Aspiration and Review of the Various Treatment Modalities Leonard LL Yeo1,2 · Priscillia PS Lye1 · Kong Wan Yee4 · Yang Cunli2,3 · Tu Tian Ming5 · Andrew FW Ho6 · Vijay K Sharma1,2 · Bernard PL Chan1,2 · Benjamin YQ Tan1,2 · Anil Gopinathan2,3 Received: 3 February 2020 / Accepted: 23 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Deep cerebral venous thrombosis (CVT) is an uncommon condition with a high morbidity and mortality. The optimal treatment approach for deep CVT remains uncertain and due to its low prevalence, randomized trials are not feasible. We showcase a straight sinus thrombosis treated with a large bore aspiration and performed a meta-analysis of the available literature to characterize and evaluate the various treatment modalities for patients with deep CVT. Methods We conducted a systematic search in PubMed, EMBASE and Ovid Medline using appropriate keywords/MESH terms search strategy. All patients with thrombosis involving the deep venous sinuses were included if treatment records were available. Outcome measures included recanalization of the affected sinus, good functional outcome assessed by a modified Rankin scale (mRS) of 0–2 or reported independent functional outcomes, permanent neurological deficits, further hemorrhage and mortality. Results A total of 69 studies comprising 120 patients were included in the analysis. Anticoagulation was the most common treatment (85.8%), whilst local intrasinus thrombolysis was performed in 40.0% of the patients and mechanical endovascular modalities were employed in 20.0% of the patients. Recanalization of the occluded sinus was seen in 83.5% of the patients while 62.6% patients achieved good functional outcome. There was considerable morbidity with 60.7% having a permanent neurological deficit, 23.3% having further hemorrhage after admission and 18.6% mortality. In the cohort receiving anticoagulation, 65.3% achieved good outcome but intracranial hemorrhage at presentation was associated with poorer outcome, permanent deficits, further bleeding and mortality. Conclusion Anticoagulation is an effective treatment strategy for deep CVT; however, patients with intracranial hemorrhage at presentation often have poorer outcomes and early endovascular strategies could be considered in this subgroup.
Keywords Deep venous thrombosis · Cerebral venous thrombosis · Endovascular · Aspiration thrombectomy · Anticoagulation
Leonard LL Yeo and Priscillia PS Lye contributed equally to this manuscript. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00062-020-00920-3) contains supplementary material, which is available to authorized users. Leonard LL Yeo
[email protected] 1
Division of Neurology, Department of Medicine, National University Health System, 1 E Kent Ridge Road, 119228 Singapore, Singapore
2
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapo
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