1
|
Quealy JB. Mechanical Thrombectomy for Aseptic, Atraumatic, Medically Refractory Cerebral Venous Sinus Thrombosis: a Systematic Review. Clin Neuroradiol 2024; 34:451-463. [PMID: 38329489 DOI: 10.1007/s00062-023-01373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/10/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) follows a severe clinical course in 13.5% of cases. Practice guidelines recommend endovascular therapy (EVT); no randomised control trials (RCTs) exist comparing EVTs. PURPOSE To determine whether specific EVTs are superior to alternatives. DATA SOURCES CENTRAL, Medline, Embase, five other databases and four clinical trials registers. Grey literature searches, reference checking, citation searching, and author contact. STUDY SELECTION All CVST cases treated with mechanical thrombectomy (MT) were includible. Paediatric, and trauma-related or infection-related thromboses were excluded. DATA ANALYSIS Standard Cochrane review procedures. Primary outcome measures; clinical efficacy (modified Rankin Score, mRS), technical efficacy (recanalisation), and clinical safety (procedure-related complications and death). Subgroup analyses were performed, comparing outcome measures between demographic groups, clinico-radiological severity, interventional strategies, and degrees of recanalisation. DATA SYNTHESIS In this study 124 papers were included (n = 486). All patients underwent MT, with 69.5% of patients receiving concomitant chemolysis. New/expanding intracerebral haemorrhage (ICH) occurred in 5.1%; non-haemorrhagic complications in 1.4%; 10.7% died. Predictors of poor efficacy included age ≥ 55 years, altered mental status (AMS), Glasgow Coma Scale (GCS) < 8. Predictive of poor safety outcomes included pre-existing ICH, deep system thrombosis, and AMS. Complete recanalisation was associated with improved clinical efficacy and safety outcomes. LIMITATIONS The review is based on case reports/series, increasing bias-risk. Myriad of potentially includible studies were necessarily excluded due to lack of requisite details. CONCLUSION Predictors of poor outcomes with medical therapy predict poor outcomes with MT; these measures should not dictate candidacy. Complete recanalisation predicts favorable clinical and safety outcomes. Local chemolysis is safe, improves recanalisation, and should be recommended, provided there is no contraindication. Clot maceration strategies and stent-retriever thrombectomy are associated with superior clinical efficacy and safety endpoints, as compared with balloon angioplasty and rheolysis.
Collapse
Affiliation(s)
- John B Quealy
- Department of Internal Medicine, UPMC Aut Even Hospital, Freshford Road, R95D370, Kilkenny, Ireland.
| |
Collapse
|
2
|
Deep cerebral venous system involvement in patients with cerebral sinus thrombosis. A proposal of neuroradiological score systems useful for clinical assessment. Neurol Sci 2023; 44:2049-2060. [PMID: 36746845 PMCID: PMC9901835 DOI: 10.1007/s10072-023-06656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 02/01/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE To develop a neuroradiological score in patients with deep cerebral venous thrombosis (DCVT), capable of assessing extension of intracranial changes and venous occlusion at diagnosis; to assess the relationship between neuroradiological and clinical features at follow-up. MATERIAL AND METHODS In 14 patients with DCVT, we developed 2 score systems on non-enhanced and contrast-enhanced CT: Intracranial Imaging Score (IIS) and Venous Occlusion Imaging Score (VOIS). ISS considers parenchymal venous strokes, hemorrhage, mass effect, and hydrocephalus; VOIS evaluates unilateral or bilateral venous occlusion extension. Modified Rankin Scale (mRS) and vessel recanalization status were assessed at follow-up. RESULTS At diagnosis, higher IIS was related to bilateral venous thrombosis involvement (p 0,02; r:0,60), but parenchymal strokes were not related to venous occlusion extension (unilateral or bilateral) (p > 0,05). Moreover, the symptoms' onset time did not correlate with the severity scores (p > 0,05). At follow-up, 8 out of 14 patients showed good clinical outcomes with complete recanalization and neurological improvement, 1 patient showed a poor neurological outcome, whereas 5 patients died within 1 week. Positive correlations were found between IIS and mRS (p 0,003, r = 0,73), between IIS and vessels' recanalization status (p 0,002, r = 0,75), and between vessels' recanalization status and mRS (p < 0,001, r = 0,98). CONCLUSION Neuroradiological scores may enhance diagnostic accuracy, and they may have a predictive significance. In patients with DCVT, although intracranial involvement was not influenced by symptoms' onset time or extension of venous occlusion, clinical outcome was related to both intracranial involvement and venous recanalization state. Collateral venous drainage status may counterbalance the thrombotic process improving prognosis.
Collapse
|
3
|
Zheng SF, Zhang YB, Xie BS, Wang HJ, Fan WJ, Chen GR, Dai LS, Yu LH, Yao PS, Kang DZ. Mechanical Thrombectomy with Tandem Double Stent Retriever in Combination with Intermediate Catheter Aspiration for Refractory Severe Hemorrhagic Cerebral Venous Sinus Thrombosis. World Neurosurg 2022; 167:e990-e997. [PMID: 36058490 DOI: 10.1016/j.wneu.2022.08.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We aimed to describe the initial experience of mechanical thrombectomy using tandem double stent retrievers combined with intermediate catheter aspiration to treat refractory severe hemorrhagic (SH)-cerebral venous sinus thrombosis (CVST). METHODS All refractory SH-CVST patients treated with mechanical thrombectomy using tandem double stent retriever (SR) combined with intermediate catheter aspiration (MT-TDSA) in our institution were retrospectively reviewed. MT-TDSA is a technique that fully engages the clot with double SRs and retrieves the clot using a double SR in combination with aspiration from an intermediate catheter. Demographics, clinical manifestation, medical history, the location of the occluded venous sinus, intraoperative details, procedure-related complications, and modified Rankin Scale (1, 6, 12 months postoperatively) were collected and analyzed. RESULTS Fourteen patients (median age, 43 years) with refractory SH-CVST were treated with MT-TDSA between January 2016 and January 2020. Ten of 14 (71.4%) had a successful intraoperative recanalization rate (>90%) using MT-TDSA. No procedure-related complications occurred. Eleven patients had good clinical outcomes (modified Rankin Scale score 0-2 at 12 months postoperatively). CONCLUSIONS MT-TDSA for refractory SH-CVST might improve clot-capturing ability and remove blood clots from cerebral venous sinuses effectively and safely, achieving good clinical outcomes.
Collapse
Affiliation(s)
- Shu-Fa Zheng
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yi-Bin Zhang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Bin-Sen Xie
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hao-Jie Wang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wen-Jian Fan
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Guo-Rong Chen
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Lin-Sun Dai
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Liang-Hong Yu
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Pei-Sen Yao
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - De-Zhi Kang
- Department of Neurosurgery, Neurosurgery Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Fujian Provincial Clinical Research Center for Neurological Disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Department of Neurosurgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Fujian Provincial Institutes of Brain Disorders and Brain Sciences, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China; Clinical research and translation center, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
| |
Collapse
|
4
|
Nepal G, Kharel S, Bhagat R, Coghlan MA, Yadav JK, Goeschl S, Lamichhane R, Phuyal S, Ojha R, Shrestha GS. Safety and efficacy of endovascular thrombectomy in patients with severe cerebral venous thrombosis: A meta-analysis. J Cent Nerv Syst Dis 2022; 14:11795735221131736. [PMID: 36204279 PMCID: PMC9530583 DOI: 10.1177/11795735221131736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022] Open
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.
Collapse
Affiliation(s)
- Gaurav Nepal
- Department of Internal Medicine,
Maharajgunj Medical Campus, Tribhuvan University Institute of
Medicine, Maharajgunj, Nepal
| | - Sanjeev Kharel
- Department of Internal Medicine,
Maharajgunj Medical Campus, Tribhuvan University Institute of
Medicine, Maharajgunj, Nepal
| | - Riwaj Bhagat
- Department of Neurology, Boston University Medical Center, Boston, MA, USA
| | - Megan A Coghlan
- Department of Neurology, University of Louisville School of
Medicine, Louisville, KY, USA
| | - Jayant K Yadav
- Department of Internal Medicine,
Maharajgunj Medical Campus, Tribhuvan University Institute of
Medicine, Maharajgunj, Nepal
| | - Stella Goeschl
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Rajan Lamichhane
- Department of Internal Medicine,
Maharajgunj Medical Campus, Tribhuvan University Institute of
Medicine, Maharajgunj, Nepal
| | - Subash Phuyal
- Department of Neuroimaging and
Interventional Neuroradiology, Upendra Devkota Memorial National Institute of
Neurological and Allied Sciences, Bansbari, Nepal
| | - Rajeev Ojha
- Department of Neurology, Tribhuvan University Teaching
Hospital, Maharajgunj, Nepal
| | - Gentle S Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching
Hospital, Maharajgunj, Nepal,Gentle S Shrestha, Department of Critical Care
Medicine, Tribhuvan University Teaching Hospital, Maharajgunj 44600, Kathmandu, Nepal.
| |
Collapse
|
5
|
Kallel N, Saidani A, Kotti A, Moussa N, Maddeh S, Gargouri R, Msaad S, Feki W. Coronavirus disease 19 (
COVID
‐19) and Cerebral venous sinus thrombosis (
CVST
): A case series and review of the literature. Clin Case Rep 2022; 10:e6143. [PMID: 35957796 PMCID: PMC9359113 DOI: 10.1002/ccr3.6143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/07/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Nesrine Kallel
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
| | - Amal Saidani
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
| | - Amina Kotti
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
| | - Nedia Moussa
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
| | - Sabrine Maddeh
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
| | - Rahma Gargouri
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
| | - Sameh Msaad
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
| | - Walid Feki
- Department of Pneumology, Hedi Chaker University Hospital Sfax Tunisia
| |
Collapse
|
6
|
Endovascular Treatment of Intracranial Vein and Venous Sinus Thrombosis—A Systematic Review. J Clin Med 2022; 11:jcm11144215. [PMID: 35887982 PMCID: PMC9319519 DOI: 10.3390/jcm11144215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/04/2022] Open
Abstract
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 (n = 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.
Collapse
|
7
|
Kalita J, Sachan A, Dubey AK, Jain N, Kumar S. A clinico-radiological study of deep cerebral venous thrombosis. Neuroradiology 2022; 64:1951-1960. [DOI: 10.1007/s00234-022-02938-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022]
|
8
|
Mu S, Li J, Lin K, Fang Y, Lin F, Li Z, Xu Y, Wang S. Predictive Factors for Early-Onset Seizures in Patients With Cerebral Venous Sinus Thrombosis. Front Neurol 2022; 13:842807. [PMID: 35422753 PMCID: PMC9001912 DOI: 10.3389/fneur.2022.842807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Seizures are reported to be important factors contributing to poor prognosis in patients with cerebral venous sinus thrombosis (CVST). However, the predictive factors for concurrent early onset seizures in patients with CVST remain unclear. To identify the predictive factors of early seizures in patients with CVST, this study retrospectively evaluated the clinical data of patients diagnosed with CVST at two centers from January 2011 to December 2020 and analyzed the relationship between admission characteristics and early onset seizures. A total of 112 CVST patients (63 men and 49 women; mean age 39.82 ± 15.70 years) were enrolled in this study, of whom 34 (30.36%) had seizures. For patients with seizures, cerebral hemorrhage, cortical vein thrombosis, anterior superior sagittal sinus (SSS) thrombosis, middle SSS thrombosis, CVST score, modified Rankin Scale, National Institute of Health Stroke Scale (NIHSS) score, neutrophil percentage, and D-dimer level were more severe than those without seizures. Logistic regression analysis showed that cerebral hemorrhage (P = 0.002), anterior SSS thrombosis (P = 0.003), NIHSS score ≥5 (P = 0.003), and D-dimer ≥0.88 mg/L (P = 0.004) were all significant predictive factors of early-onset seizures in CVST patients. Combining the four factors further improved the predictive capability with an area under the curve of 0.871 (95% confidence interval = 0.803–0.939). Further large-scale prospective studies are required to confirm these findings.
Collapse
Affiliation(s)
- Shuwen Mu
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jun Li
- Department of Neurosurgery, 900th Hospital, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Kunzhe Lin
- Department of Neurosurgery, Affiliated Fuzhou First Hospital of Fujian Medical University, Fuzhou, China
| | - Yi Fang
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Feng Lin
- School of Medicine, Xiamen University, Xiamen, China
| | - Ziqi Li
- School of Medicine, Xiamen University, Xiamen, China
| | - Yongjun Xu
- Laboratory of Basic Medicine, 900th Hospital, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- Yongjun Xu
| | - Shousen Wang
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Neurosurgery, 900th Hospital, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Shousen Wang
| |
Collapse
|
9
|
Abbas Z, Chaudhary A. COVID-19 Associated Coagulopathy Resulting in Cerebral Venous Thrombosis and Pulmonary Embolism. Cureus 2021; 13:e19602. [PMID: 34926071 PMCID: PMC8674063 DOI: 10.7759/cureus.19602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 12/11/2022] Open
Abstract
Venous stroke is an infrequent complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease. Coronavirus disease 2019 (COVID-19) acts as a causative factor for thromboembolic events such as pulmonary embolism (PE), deep vein thrombosis (DVT), stroke (ischemic or hemorrhagic), and myocardial infarction. We report a case of cerebral venous thrombosis (CVT) following severe COVID-19 infection, with co-incidence of pulmonary thromboembolism. A 39-year-old English lady presented with fever and cough; subsequently, she was diagnosed with COVID-19 and was managed in the high dependency unit (HDU) due to the severity of symptoms; she received dexamethasone and tocilizumab. Her condition improved and she was discharged, but presented again after 15 days due to headache and left-sided weakness. Her neurological examination confirmed nystagmus, past pointing, and dysdiadochokinesia positive on the left side. Initial blood investigations showed D-dimer being raised at 1875 ng/ml. Head CT venogram reported evidence of thrombus in the superior sagittal sinus, left transverse sinus, and inferior sagittal sinus consistent with venous sinus thrombosis. She also underwent CT pulmonary angiogram (CTPA) which revealed lingular acute segmental PE and patchy ground-glass shadowing throughout both lung fields, confirming recent infective COVID-19 changes. She was started on a therapeutic dose of dalteparin (low-molecular-weight heparin). Luckily she made a good recovery from her neurological symptoms. Like this case and many other reported cases, COVID-19 acts as an independent risk factor for increased coagulopathy. Clinicians should maintain a high index of suspicion for CVT to aid in timely diagnosis and prompt treatment to save lives.
Collapse
Affiliation(s)
- Zaira Abbas
- Stroke Medicine, Blackpool Teaching Hospitals, Blackpool, GBR
| | - Ali Chaudhary
- Stroke Medicine, Blackpool Teaching Hospitals, Blackpool, GBR
| |
Collapse
|
10
|
Şimşek F, Tosunoğlu R. Massive cerebral venous thrombosis and venous watershed infarction as late complications of COVID-19: a case report. Neurol Sci 2021; 42:4421-4423. [PMID: 34373991 PMCID: PMC8352747 DOI: 10.1007/s10072-021-05513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/18/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Fatma Şimşek
- Department of Neurology, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
| | - Ravza Tosunoğlu
- Department of Neurology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| |
Collapse
|
11
|
Dubey AK, Kalita J, Chaudhary SK, Misra UK. Impact of anticoagulation status on recanalization and outcome of cerebral venous thrombosis. J Clin Neurosci 2021; 89:43-50. [PMID: 34119293 DOI: 10.1016/j.jocn.2021.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/23/2021] [Accepted: 04/17/2021] [Indexed: 11/26/2022]
Abstract
Effective anticoagulation status may determine the recanalization and outcome of cerebral venous thrombosis (CVT). We report impact of anticoagulation status on recanalization and outcome of CVT. This is a retrospective study on 126 patients with CVT diagnosed on magnetic resonance venography (MRV). Their clinical features and risk factors were noted. The data were retrieved from a prospectively maintained registry, and international normalized ratio (INR) was noted after discharge till 3 months. All the patients were on acenocoumarol. Based on INR value, patients were categorized as Group A (effective anticoagulation INR within the therapeutic range or above) and Group B (ineffective anticoagulation INR > 50% below the therapeutic range). A repeat MRV at 3 months was done for recanalization. Outcome at 3 months was evaluated using modified Rankin Scale (mRS), and categorized as good (mRS ≤ 2) and poor (mRS 2 or more) 101(80.2%) patients were in group A and 25(19.8%) in group B. Their demographic, risk factors, magnetic resonance imaging (MRI) and MRV findings were comparable. On repeat MRV, recanalization occurred in 22/24(91.7%); 15(88%) in group A and 7(100%) in group B. Recanalization was independent of coagulation status. Seven (5.6%) patients died and 107(84.9%) had good outcome; 85(84.2%) in group A and 22(88%) in group B. Kaplan Meier analysis also did not reveal survival or good outcome benefits between the groups. In CVT, outcome and recanalization at 3 months are not dependent on coagulation status. Further prospective studies are needed regarding duration of anticoagulant and its impact on recanalization and outcome.
Collapse
Affiliation(s)
- Ashish K Dubey
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, Uttar Pradesh 226014, India
| | - Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, Uttar Pradesh 226014, India.
| | - Sarvesh K Chaudhary
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, Uttar Pradesh 226014, India
| | - Usha K Misra
- Apollo Medics Super-specialty Hospitals and Senior consultant neurologist, Vivekanand Polyclinic, and Institute of Medical science, Lucknow 226001, India
| |
Collapse
|
12
|
Ferrante E, Trimboli M, Petrecca G, Allegrini F. Cerebral venous thrombosis in spontaneous intracranial hypotension: A report of 8 cases and review of the literature. J Neurol Sci 2021; 425:117467. [PMID: 33894614 DOI: 10.1016/j.jns.2021.117467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/30/2021] [Accepted: 04/16/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The occurrence of cerebral venous thrombosis (CVT) in patients with spontaneous intracranial hypotension (SIH) raises difficult practical questions regarding the management of the two conditions. The first-line therapy for CVT is anticoagulation (AC); however, its potential benefit in SIH/CVT patients, especially if complicated by subdural haematoma, must be carefully evaluated taking account of the intracranial haemorrhage risk. Venous system recanalization and good prognosis in SIH/CVT patients treated with epidural blood patch (EBP), the main treatment option for SIH, have been already described. METHODS We reviewed our cases of SIH complicated by CVT among a cohort of 445 SIH patients observed and treated during the last years. All published case reports and case series reporting patients with SIH and CVT were also ascertained and reviewed. RESULTS Eight (2%) out of 445 patients suffering with SIH, were also diagnosed with CVT. All patients observed had orthostatic headache, three of them experienced a change in their headache pattern over the SIH course. Six out of eight patients received both AC and EBP treatments. Two patients were treated using only AC or EBP. A bilateral subdural haematoma enlargement after 1 month of AC was observed in one case. Complete CVT recanalization after treatment was obtained in three patients, including two with multiple CVT at baseline; partial CVT recanalization was achieved in two patients. Three patients experienced no CVT recanalization. After 6-48 months' follow-up all patients were still asymptomatic. CONCLUSIONS The use of AC therapy should be weighed against the intracranial haemorrage risk and should be monitored carefully if initiated. Effective and prompt EBP, even without AC therapy, might lead to a good prognosis in selected cases.
Collapse
Affiliation(s)
- Enrico Ferrante
- Neurology Department, AOR San Carlo, Potenza (IT), Italy; Neurology Department, Alto Vicentino Hospital, AULSS 7 Pedemontana, Santorso (IT), Italy; Neurology Department, Niguarda Ca Granda Hospital, Milan (IT), Italy.
| | - Michele Trimboli
- Neurology Department, AOR San Carlo, Potenza (IT), Italy; Institute of Neurology Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro (IT), Italy.
| | | | - Francesco Allegrini
- Anesthesiology and Intensive Care Department, AOR San Carlo, Potenza (IT), Italy
| |
Collapse
|
13
|
Krajíčková D, Král J, Herzig R, Klzo Ľ, Krajina A, Havelka J, Šimůnek L, Vyšata O, Van Quang T, Bar M, Vališ M. Factors influencing therapy choice and clinical outcome in cerebral venous sinus thrombosis. Sci Rep 2020; 10:21633. [PMID: 33303787 PMCID: PMC7728772 DOI: 10.1038/s41598-020-78434-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 11/02/2020] [Indexed: 11/09/2022] Open
Abstract
We aimed was to assess the factors influencing therapy choice and clinical outcome after 3-4 months in patients with cerebral venous sinus thrombosis (CVST). In a retrospective, bi-centric study, the set consisted of 82 consecutive CVST patients (61 females; mean age 33.5 ± 15.7 years). Following data were collected: baseline characteristics, presence of gender-specific risk factors (GSRF), location and extent of venous sinus impairment, clinical presentation, type of treatment, recanalization, presence of parenchymal lesions, and clinical outcome after 3-4 months (assessed using the modified Rankin Scale [mRS], with excellent outcome defined as mRS 0-1). Multivariate logistic regression analysis was used for statistical evaluation. After 3-4 months, complete recovery was achieved in 41 (50%) and excellent clinical outcome in 67 (81.7%) patients. Female sex (OR 0.11; p = 0.0189) and presence of focal neurologic deficit (OR 0.16; p = 0.0165) were identified as significant independent negative predictors and, the presence of GSRF (OR 15.63; p = 0.0011) as significant independent positive predictor of excellent clinical outcome. In conclusion, in our CVST patients, the presence of GSRF was associated with excellent clinical outcome, while the female sex itself was associated with poorer clinical outcome.
Collapse
Affiliation(s)
- Dagmar Krajíčková
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Jiří Král
- Department of Neurology, University Hospital Ostrava and University of Ostrava Faculty of Medicine, 708 52, Ostrava, Czech Republic.,Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, 656 91, Brno, Czech Republic
| | - Roman Herzig
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Ľudovít Klzo
- Department of Radiology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Antonín Krajina
- Department of Radiology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Jaroslav Havelka
- Department of Radiology, University Hospital Ostrava and University of Ostrava Faculty of Medicine, 708 52, Ostrava, Czech Republic
| | - Libor Šimůnek
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Oldřich Vyšata
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic
| | - Tran Van Quang
- Department of Mathematics, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University, 160 00, Prague, Czech Republic
| | - Michal Bar
- Department of Neurology, University Hospital Ostrava and University of Ostrava Faculty of Medicine, 708 52, Ostrava, Czech Republic
| | - Martin Vališ
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, 500 05, Hradec Králové, Czech Republic.
| |
Collapse
|
14
|
Tu TM, Goh C, Tan YK, Leow AS, Pang YZ, Chien J, Shafi H, Chan BP, Hui A, Koh J, Tan BY, Umapathi NT, Yeo LL. Cerebral Venous Thrombosis in Patients with COVID-19 Infection: a Case Series and Systematic Review. J Stroke Cerebrovasc Dis 2020; 29:105379. [PMID: 33254369 PMCID: PMC7538072 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105379] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/08/2020] [Accepted: 09/29/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There has been increasing reports associating the coronavirus disease 2019 (COVID-19) with thromboembolic phenomenon including ischemic strokes and venous thromboembolism. Cerebral venous thrombosis (CVT) is a rare neurovascular emergency that has been observed in some COVID-19 patients, yet much remains to be learnt of its underlying pathophysiology. OBJECTIVE We present a case series of local patients with concomitant COVID-19 infection and CVT; and aim to perform a systematic review of known cases in the current literature. METHODS We describe two patients with concomitant COVID-19 infection and CVT from a nationwide registry in Singapore. We then conducted a literature search in PubMed and Embase using a suitable keyword search strategy from 1st December 2019 to 11th June 2020. All studies reporting CVT in COVID-19 patients were included. RESULTS Nine studies and 14 COVID-19 patients with CVT were studied. The median age was 43 years (IQR=36-58) and majority had no significant past medical conditions (60.0%). The time taken from onset of COVID-19 symptoms to CVT diagnosis was a median of 7 days (IQR=6-14). CVT was commonly seen in the transverse (75.0%) and sigmoid sinus (50.0%); 33.3% had involvement of the deep venous sinus system. A significant proportion of patients had raised D-dimer (75.0%) and CRP levels (50.0%). Two patients reported presence of antiphospholipid antibodies. Most patients received anticoagulation (91.7%) while overall mortality rate was 45.5%. CONCLUSIONS The high mortality rate of CVT in COVID-19 infection warrants a high index of suspicion from physicians, and early treatment with anticoagulation should be initiated.
Collapse
Affiliation(s)
- Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Claire Goh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ying Kiat Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Aloysius St Leow
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Yu Zhi Pang
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Jaime Chien
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Humaira Shafi
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Bernard Pl Chan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Andrew Hui
- Division of Neurology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Jasmine Koh
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Benjamin Yq Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore
| | | | - Leonard Ll Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore.
| |
Collapse
|