Endovascular Treatment of Intracranial Vein and Venous Sinus Thrombosis—A Systematic Review
Background: Cerebral venous sinus or vein thromboses (SVT) are treated with heparin followed by oral anticoagulation. Even after receiving the best medical treatment, numerous patients experience neurological deterioration, intracerebral hemorrhage or brain edema. Debate regarding whether endovascul...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-07-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/11/14/4215 |
| _version_ | 1797405958099435520 |
|---|---|
| author | Philipp Bücke Victoria Hellstern Alexandru Cimpoca José E. Cohen Thomas Horvath Oliver Ganslandt Hansjörg Bäzner Hans Henkes |
| author_facet | Philipp Bücke Victoria Hellstern Alexandru Cimpoca José E. Cohen Thomas Horvath Oliver Ganslandt Hansjörg Bäzner Hans Henkes |
| author_sort | Philipp Bücke |
| collection | DOAJ |
| description | Background: Cerebral venous sinus or vein thromboses (SVT) are treated with heparin followed by oral anticoagulation. Even after receiving the best medical treatment, numerous patients experience neurological deterioration, intracerebral hemorrhage or brain edema. Debate regarding whether endovascular treatment (EVT) is beneficial in such severe cases remains ongoing. This systematic review summarizes the current evidence supporting the use of EVT for SVT on the basis of case presentations, with a focus on patient selection, treatment strategies and the effects of the COVID-19 pandemic. Methods: This systemic literature review included randomized controlled trials (RCTs) and retrospective observational data analyzing five or more patients. Follow-up information (modified Rankin scale (mRS)) was required to be provided (individual patient data). Results: 21 records (<i>n</i> = 405 patients; 1 RCT, 20 observational studies) were identified. EVT was found to be feasible and safe in a highly selected patient cohort but was not associated with an increase in good functional outcomes (mRS 0–2) in RCT data. In observational data, good functional outcomes were frequently observed despite an anticipated poor prognosis. Conclusion: The current evidence does not support the routine incorporation of EVT in SVT treatment. However, in a patient cohort prone to poor prognosis, EVT might be a reasonable therapeutic option. Further studies determining the patients at risk, choice of methods and devices, and timing of treatment initiation are warranted. |
| first_indexed | 2024-03-09T03:18:45Z |
| format | Article |
| id | doaj.art-4079dd8a05304f9980a822bdf1feb87d |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T03:18:45Z |
| publishDate | 2022-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-4079dd8a05304f9980a822bdf1feb87d2023-12-03T15:13:58ZengMDPI AGJournal of Clinical Medicine2077-03832022-07-011114421510.3390/jcm11144215Endovascular Treatment of Intracranial Vein and Venous Sinus Thrombosis—A Systematic ReviewPhilipp Bücke0Victoria Hellstern1Alexandru Cimpoca2José E. Cohen3Thomas Horvath4Oliver Ganslandt5Hansjörg Bäzner6Hans Henkes7Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandNeuroradiologische Klinik, Klinikum Stuttgart, 70174 Stuttgart, GermanyNeuroradiologische Klinik, Klinikum Stuttgart, 70174 Stuttgart, GermanyDepartment of Neurosurgery, Hadassah Medical Center, Hebrew University Jerusalem, Jerusalem 9103401, IsraelDepartment of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, SwitzerlandNeurochirurgische Klinik, Klinikum Stuttgart, 70174 Stuttgart, GermanyNeurologische Klinik, Klinikum Stuttgart, 70174 Stuttgart, GermanyNeuroradiologische Klinik, Klinikum Stuttgart, 70174 Stuttgart, GermanyBackground: Cerebral venous sinus or vein thromboses (SVT) are treated with heparin followed by oral anticoagulation. Even after receiving the best medical treatment, numerous patients experience neurological deterioration, intracerebral hemorrhage or brain edema. Debate regarding whether endovascular treatment (EVT) is beneficial in such severe cases remains ongoing. This systematic review summarizes the current evidence supporting the use of EVT for SVT on the basis of case presentations, with a focus on patient selection, treatment strategies and the effects of the COVID-19 pandemic. Methods: This systemic literature review included randomized controlled trials (RCTs) and retrospective observational data analyzing five or more patients. Follow-up information (modified Rankin scale (mRS)) was required to be provided (individual patient data). Results: 21 records (<i>n</i> = 405 patients; 1 RCT, 20 observational studies) were identified. EVT was found to be feasible and safe in a highly selected patient cohort but was not associated with an increase in good functional outcomes (mRS 0–2) in RCT data. In observational data, good functional outcomes were frequently observed despite an anticipated poor prognosis. Conclusion: The current evidence does not support the routine incorporation of EVT in SVT treatment. However, in a patient cohort prone to poor prognosis, EVT might be a reasonable therapeutic option. Further studies determining the patients at risk, choice of methods and devices, and timing of treatment initiation are warranted.https://www.mdpi.com/2077-0383/11/14/4215cerebral venous sinus thrombosisendovascular therapythrombolysisthrombectomyintracerebral hemorrhageanticoagulation |
| spellingShingle | Philipp Bücke Victoria Hellstern Alexandru Cimpoca José E. Cohen Thomas Horvath Oliver Ganslandt Hansjörg Bäzner Hans Henkes Endovascular Treatment of Intracranial Vein and Venous Sinus Thrombosis—A Systematic Review Journal of Clinical Medicine cerebral venous sinus thrombosis endovascular therapy thrombolysis thrombectomy intracerebral hemorrhage anticoagulation |
| title | Endovascular Treatment of Intracranial Vein and Venous Sinus Thrombosis—A Systematic Review |
| title_full | Endovascular Treatment of Intracranial Vein and Venous Sinus Thrombosis—A Systematic Review |
| title_fullStr | Endovascular Treatment of Intracranial Vein and Venous Sinus Thrombosis—A Systematic Review |
| title_full_unstemmed | Endovascular Treatment of Intracranial Vein and Venous Sinus Thrombosis—A Systematic Review |
| title_short | Endovascular Treatment of Intracranial Vein and Venous Sinus Thrombosis—A Systematic Review |
| title_sort | endovascular treatment of intracranial vein and venous sinus thrombosis a systematic review |
| topic | cerebral venous sinus thrombosis endovascular therapy thrombolysis thrombectomy intracerebral hemorrhage anticoagulation |
| url | https://www.mdpi.com/2077-0383/11/14/4215 |
| work_keys_str_mv | AT philippbucke endovasculartreatmentofintracranialveinandvenoussinusthrombosisasystematicreview AT victoriahellstern endovasculartreatmentofintracranialveinandvenoussinusthrombosisasystematicreview AT alexandrucimpoca endovasculartreatmentofintracranialveinandvenoussinusthrombosisasystematicreview AT joseecohen endovasculartreatmentofintracranialveinandvenoussinusthrombosisasystematicreview AT thomashorvath endovasculartreatmentofintracranialveinandvenoussinusthrombosisasystematicreview AT oliverganslandt endovasculartreatmentofintracranialveinandvenoussinusthrombosisasystematicreview AT hansjorgbazner endovasculartreatmentofintracranialveinandvenoussinusthrombosisasystematicreview AT hanshenkes endovasculartreatmentofintracranialveinandvenoussinusthrombosisasystematicreview |