Department of Neurology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Campus, Virchow-Klinikum, Berlin, Germany.
Neurocrit Care. 2024 Apr;40(2):621-632. doi: 10.1007/s12028-023-01782-6. Epub 2023 Jul 27.
Clinical observations indicated that vaccine-induced immune thrombosis with thrombocytopenia (VITT)-associated cerebral venous sinus thrombosis (CVST) often has a space-occupying effect and thus necessitates decompressive surgery (DS). While comparing with non-VITT CVST, this study explored whether VITT-associated CVST exhibits a more fulminant clinical course, different perioperative and intensive care unit management, and worse long-term outcome.
This multicenter, retrospective cohort study collected patient data from 12 tertiary centers to address priorly formulated hypotheses concerning the clinical course, the perioperative management with related complications, extracerebral complications, and the functional outcome (modified Rankin Scale) in patients with VITT-associated and non-VITT CVST, both with DS.
Both groups, each with 16 patients, were balanced regarding demographics, kind of clinical symptoms, and radiological findings at hospital admission. Severity of neurological symptoms, assessed with the National Institute of Health Stroke Scale, was similar between groups at admission and before surgery, whereas more patients with VITT-associated CVST showed a relevant midline shift (≥ 4 mm) before surgery (100% vs. 68.8%, p = 0.043). Patients with VITT-associated CVST tended to undergo DS early, i.e., ≤ 24 h after hospital admission (p = 0.077). Patients with VITT-associated CVST more frequently received platelet transfusion, tranexamic acid, and fibrinogen perioperatively. The postoperative management was comparable, and complications were evenly distributed. More patients with VITT-associated CVST achieved a favorable outcome (modified Rankin Scale ≤ 3) at 3 months (p = 0.043).
Although the prediction of individual courses remains challenging, DS should be considered early in VITT-associated CVST because an overall favorable outcome appears achievable in these patients.
临床观察表明，疫苗诱导的免疫血栓形成伴血小板减少症（VITT）相关的颅内静脉窦血栓形成（CVST）常具有占位效应，因此需要减压手术（DS）。本研究比较了 VITT 相关 CVST 与非 VITT CVST，探讨 VITT 相关 CVST 是否具有更暴发性的临床病程、不同的围手术期和重症监护病房管理以及更差的长期结局。
这项多中心回顾性队列研究从 12 家三级中心收集患者数据，以解决先前提出的关于 VITT 相关和非 VITT CVST 患者的临床病程、围手术期管理及其相关并发症、颅外并发症和功能结局（改良 Rankin 量表）的假设。两组均进行了 DS。
两组在人口统计学特征、入院时的临床症状类型和影像学发现方面均平衡。入院时和手术前，两组的神经症状严重程度（采用国立卫生研究院卒中量表评估）相似，而更多的 VITT 相关 CVST 患者在手术前有明显的中线移位（≥4mm）（100%比 68.8%，p=0.043）。VITT 相关 CVST 患者倾向于早期进行 DS，即入院后≤24h（p=0.077）。VITT 相关 CVST 患者围手术期更常接受血小板输注、氨甲环酸和纤维蛋白原。术后管理相似，并发症分布均匀。更多的 VITT 相关 CVST 患者在 3 个月时获得良好结局（改良 Rankin 量表≤3）（p=0.043）。
尽管个别病程的预测仍然具有挑战性，但 VITT 相关 CVST 应考虑早期进行 DS，因为这些患者总体预后良好。
