Abstract 358: Outcomes of Endovascular Thrombectomy in Patients with Cerebral Venous Thrombosis: A Nationwide Inpatient Sample Analysis
Authors: Jain A. , Malhotra A. , Spirollari E. , Kaddoura R. , Arthur M. C. , Sacknovitz A. , Al‐Mufti F. 
Published: January 2025

Introduction/Purpose

Cerebral venous thrombosis (CVT) is a rare condition that presents with significant treatment challenges and has traditionally been managed with anticoagulation. However, for patients who fail anticoagulation or present with severe symptoms, endovascular thrombectomy (EVT) has emerged as a favorable treatment modality. This study examines the outcomes, complications, and comorbidities associated with EVT in patients with CVT.

Methods

A query of the 2015‐2019 National (Nationwide) Inpatient Sample was performed for patients admitted to hospitals with ICD‐10 diagnosis codes for CVT and ICD‐10 procedure codes for usage of EVT. Demographic information, baseline comorbidities, complications, and discharge dispositions were compared between patients who underwent EVT and those who were managed medically. A multivariate logistic regression was performed to determine independent predictors of outcomes, while controlling for age, gender, cerebral edema/herniation, hemorrhage, mechanical ventilation, Elixhauser Comorbidity Index, and National Institute of Health Stroke Scale (NIHSS) severity. All statistical analyses were performed using Statistical Product and Service Solutions (SPSS, V. 29).

Results

A total of 36,005 patients diagnosed with CVT were identified from 2015(Q4)‐2019. Of these patients, 325 (0.9%) received EVT. Patients who underwent EVT were older (49.28±19.078 years vs. 43.62±23.294 years, p<0.001), more likely to be female (61.5% vs. 54.8%, p=0.016), and had higher rates of comorbidities, such as diabetes mellitus (18.5% vs. 13.5%, p=0.012), hypertension (47.7% vs. 31.3%, p<0.001), and obesity (13.8% vs. 8.1%, p<0.001). These patients also presented with more severe neurological symptoms, including higher NIHSS scores (13.15 vs. 6.17, p<0.001), coma (30.8% vs. 11.2%, p<0.001), and cerebral edema (43.1% vs. 15.5%, p<0.001). Patients who instead received medical management had higher rates of sepsis (4.7% vs 1.5%, p=0.008) and were more likely to undergo subsequent decompressive craniectomy (1.9% vs 0%, p=0.011). With regards to clinical outcomes, patients undergoing EVT had a higher incidence of in‐hospital mortality (15.4% vs. 4.6%, p = 0.007), were less likely to be discharged routinely (29.2% vs. 57%, p<0.001), and more likely to be transferred to a skilled nursing facility (44.6% vs. 20%, p<0.001). They also experienced higher rates of complications, such as pulmonary embolism (7.7% vs. 3%, p<0.001) and hemiplegia (33.8% vs. 10.5%, p<0.001).

Conclusions

In this nationally‐representative analysis, patients with CVT who underwent EVT were older, had higher income, were more likely to be female, and presented with more severe neurological conditions. After controlling for severity, EVT in patients with CVT was associated with significant risks, including higher rates of complications and inpatient mortality. Despite this, EVT remains a crucial treatment option for patients who fail anticoagulation therapy. Careful patient selection and management of comorbidities are essential in optimizing clinical outcomes.