Outcomes of Endovascular Thrombectomy in Patients with Cerebral Venous Thrombosis: A Cohort Study of 36,005 Patients
Authors: Malhotra Aryan , Jain Ankita , Spirollari Eris , Kaddoura Rachid , Arthur Melinda Christine , Sacknovitz Ariel , Nawaiseh Mohammed B. , Medicherla Chaitanya , Kaur Gurmeen , Santarelli Justin , Gandhi Chirag D. , Al-Mufti Fawaz 
Published: October 2024

Introduction/Purpose

Cerebral venous thrombosis (CVT) is a rare condition that presents 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 option.

Objective

The primary aim of this study is to evaluate the outcomes, complications, and comorbidities associated with EVT in patients with CVT.

Methods

A query of the 2015-2019 National (Nationwide) Inpatient Sample (NIS) was performed for patients admitted to hospitals with ICD-10 diagnosis codes for CVT. The usage of endovascular thrombectomy was identified using ICD-10 procedure codes. 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. Odds ratios (OR) were calculated for each complication/outcome. Statistical significance was set at an alpha level of 0.05. All statistical analyses were performed using Statistical Product and Service Solutions (SPSS) Statistical Software Version 29.

Results

A total of 36,005 patients diagnosed with CVT were identified from 2015(Q4)-2019; of those, 325 (0.9%) underwent EVT. Patients who underwent EVT were older (49.28±19.08years vs 43.62±23.29 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).

Patients undergoing EVT had a higher incidence of in-hospital mortality (15.4% vs. 4.6%, OR 1.627, p = 0.007), were less likely to be discharged routinely (29.2% vs. 57%, OR 0.599, p < 0.001), and more likely to be transferred to a skilled nursing facility (44.6% vs. 20%, OR 3.22, p < 0.001). They also experienced higher rates of concomitant conditions, 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. Our results indicate that EVT in patients with CVT is associated with significant risks, including higher rates of inpatient mortality. Although our analysis attempts to adjust for confounding differences, it remains challenging to fully account for the increased baseline morbidity in patients undergoing EVT. As a result, the poorer outcomes observed in this cohort potentially reflect the severity of illness in these patients rather than the risks associated with EVT itself. Nonetheless, EVT remains an important treatment option for patients who fail medical management. Careful patient selection and tailored management strategies are essential to minimize risks and improve outcomes in this high-risk population. Further studies should focus on developing precise patient selection criteria to better identify which patients with CVT are most likely to benefit from EVT.