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Stroke. 2015 May;46(5):1263-8. doi: 10.1161/STROKEAHA.114.007465. Epub 2015 Apr 21.

Mechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases.

Author information

1
From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S., S.D.); Department of Neurology, UT Southwestern Medical Center, Dallas, TX (F.M.S., C.B., M.J.); Department of Neurology, Academic Medical Hospital, University of Amsterdam, Amsterdam, The Netherlands (S.M.Z., J.S., J.M.C.); and Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada (J.M.C.). fazeelmukhtar@gmail.com.
2
From the Department of Neurology, Southern Illinois University School of Medicine, Springfield (F.M.S., S.D.); Department of Neurology, UT Southwestern Medical Center, Dallas, TX (F.M.S., C.B., M.J.); Department of Neurology, Academic Medical Hospital, University of Amsterdam, Amsterdam, The Netherlands (S.M.Z., J.S., J.M.C.); and Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada (J.M.C.).

Abstract

BACKGROUND AND PURPOSE:

Cerebral venous thrombosis is generally treated with anticoagulation. However, some patients do not respond to medical therapy and these might benefit from mechanical thrombectomy. The aim of this study was to gain a better understanding of the efficacy and safety of mechanical thrombectomy in patients with cerebral venous thrombosis, by performing a systematic review of the literature.

METHODS:

We identified studies published between January 1995 and February 2014 from PubMed and Ovid. We included all cases of cerebral venous thrombosis in whom mechanical thrombectomy was performed with or without intrasinus thrombolysis. Good outcome was defined as normal or mild neurological deficits at discharge (modified Rankin Scale, 0-2). Secondary outcome variables included periprocedural complications and recanalization rates.

RESULTS:

Our study included 42 studies (185 patients). Sixty percent of patient had a pretreatment intracerebral hemorrhage and 47% were stuporous or comatose. AngioJet was the most commonly used device (40%). Intrasinus thrombolysis was used in 131 patients (71%). Overall, 156 (84%) patients had a good outcome and 22 (12%) died. Nine (5%) patients had no recanalization, 38 (21%) had partial, and 137 (74%) had near to complete recanalization. The major periprocedural complication was new or increased intracerebral hemorrhage (10%). The use of AngioJet was associated with lower rate of complete recanalization (odds ratio, 0.2; 95% confidence interval, 0.09-0.4) and lower chance of good outcome (odds ratio, 0.5; 95% confidence interval, 0.2-1.0).

CONCLUSIONS:

Our systematic review suggests that mechanical thrombectomy is reasonably safe but controlled studies are required to provide a definitive answer on its efficacy and safety in patients with cerebral venous thrombosis.

KEYWORDS:

thrombectomy; thrombolytic therapy

PMID:
25899238
DOI:
10.1161/STROKEAHA.114.007465
[Indexed for MEDLINE]

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