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 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.

Automated summary

This systematic review examines the use of endovascular treatment (EVT) for cerebral venous sinus/vein thromboses (SVT), focusing on patient selection, treatment strategies, and the impact of the COVID-19 pandemic. The study found that EVT was feasible and safe in a highly selected patient cohort, but did not lead to increased favorable functional outcomes according to randomized controlled trial (RCT) data. However, observational data showed frequent good functional outcomes despite an anticipated poor prognosis. Further research is needed to identify high-risk patients, determine optimal methods and devices, and establish best timing for treatment initiation.