Neurology Department and Stroke Unit, Shohada-Tajrish Tertiary University Hospital, Shahid-Beheshti University of Medical Sciences, Tehran, Iran.
Radiology Department, Eastern Clinical University Hospital, Stradins University, Riga, Latvia.
Interv Neuroradiol. 2024 Oct;30(5):746-758. doi: 10.1177/15910199221143418. Epub 2022 Dec 5.
Cerebral venous sinus thrombosis (CVST) is an uncommon but fatal cause of stroke worldwide. Endovascular treatments could be life-saving in patients who don't treat with anticoagulants as a mainstay of treatment. Currently, there is no consensus considering the safety, efficacy, and also selected approaches of endovascular intervention for these patients. This systematic review evaluates the literature on endovascular thrombolysis (EVT) in CVST patients.
A comprehensive search was conducted through PubMed and Scopus databases between 2010 and 2021, with additional sources identified through cross-referencing. The primary outcomes were the safety and efficacy of EVT in CVST, including catheter-related and non-catheter-related complications, clinical outcomes, and radiological outcomes.
A total of 10 studies comprising 339 patients were included. Most of the patients presented with headaches (86.72%) and/or focal neurologic deficits (45.43%) (modified Rankin Scale of 5 in 55.88%). Acquired coagulopathy and/or consuming estrogen/progesterone medication were the most frequent predisposing factors (45.59%). At presentation, 68.84% had multi-sinus involvement, and 28.90% had venous infarcts and/or intracranial hemorrhage (ICH). The overall complication rate was 10.3%, with a 2.94%, 1.47%, and 1.17% rate of ICH, herniation, and intracranial edema, respectively. The complete and partial postoperative radiographic resolution was reported in 89.97% of patients, increasing to 95.21% during the follow-up. Additionally, 72.22% of patients had no or mild neurologic deficit at discharge, rising to 91.18% at the last follow-up. The overall mortality rate was 7.07%.
EVT can be an effective and safe treatment option for patients with refractory CVST or contraindications to systemic anticoagulation.
脑静脉窦血栓形成（CVST）是全球范围内一种罕见但致命的卒中病因。对于不接受抗凝治疗作为主要治疗方法的患者，血管内治疗可能具有救生作用。目前，对于这些患者，血管内介入治疗的安全性、疗效以及选择方法尚没有共识。本系统评价评估了 CVST 患者血管内溶栓（EVT）的文献。
通过 PubMed 和 Scopus 数据库进行全面检索，检索时间范围为 2010 年至 2021 年，并通过交叉引用确定了其他来源。主要结局是 CVST 患者 EVT 的安全性和疗效，包括导管相关和非导管相关并发症、临床结局和影像学结局。
共纳入 10 项研究，共 339 例患者。大多数患者表现为头痛（86.72%）和/或局灶性神经功能缺损（45.43%）（改良 Rankin 量表评分为 5 分的占 55.88%）。获得性凝血障碍和/或服用雌激素/孕激素药物是最常见的易患因素（45.59%）。在就诊时，68.84%的患者有多窦受累，28.90%的患者有静脉梗死和/或颅内出血（ICH）。总体并发症发生率为 10.3%，ICH、脑疝和颅内水肿的发生率分别为 2.94%、1.47%和 1.17%。89.97%的患者术后影像学完全和部分缓解，随访时增加至 95.21%。此外，72.22%的患者出院时无或轻度神经功能缺损，随访时上升至 91.18%。总的死亡率为 7.07%。
EVT 可以成为对全身抗凝治疗有抵抗或有禁忌证的 CVST 患者的一种有效且安全的治疗选择。
