Abstract 129: Endovascular Therapy in Cerebral Venous Thrombosis: Nationwide Insights and Implications for Mortality
Authors: Shu Liqi , Lee Elizabeth M. , Klein Piers , Abdalkader Mohamad , Nguyen Thanh , Yaghi Shadi , Field Thalia , Zhou Lily 
Published: March 2024

Introduction
Cerebral Venous Thrombosis (CVT) is a rare cerebrovascular condition causing death or functional dependency in 10‐15%. Although Endovascular Therapy (EVT) is deployed variably across centers for managing CVT, the determinants and consequences of such use remain under‐explored. We examined the demographic and clinical correlates of EVT use in CVT and assessed its impact on patient outcomes utilizing a national database.

Methods
We identified CVT cases from 2015 to 2020 in the National Inpatient Sample, with EVT as the primary exposure. CVT and other diagnoses, and EVT and other procedures, were identified using standard ICD 10 codes. A backward stepwise regression model (at p<0.05) was used to explore patient demographics, hospital characteristics, and comorbidities significantly associated with EVT use. We examined the association between EVT use and in‐hospital mortality using survey weighted unadjusted and adjusted logistic regression models. Covariates in the model one assessing inpatient mortality included age, insurance status, hospital teaching status, hospital volume size, central nervous system (CNS) infections, CNS cancer, other types of cancer, hematological disorder, traumatic head injuries, seizure, intubation, and transfer from an outside hospital. Model two additionally adjusted for female sex, NIH Stroke Scale (NIHSS), and Elixhauser mortality index.

Results
We identified 48,835 individuals with CVT, of whom 1,275 (2.6%) underwent EVT. The stepwise regression analysis revealed a higher likelihood of receiving EVT with older age (OR per year: 1.01, 95% CI: 1.01‐1.02, p<0.001), presence of a hematological disorder (OR: 2.06, 95% CI: 1.58‐2.67, p<0.001), seizure (OR: 1.54, 95% CI: 1.09‐2.16, p=0.014), intubation (OR: 3.85, 95% CI: 2.78‐5.34, p<0.001), higher NIHSS (10.5[4‐18] versus 3[1‐8], p<0.001), or admission to a teaching hospital (OR: 4.15, 95% CI: 1.93‐8.92, p<0.001), high‐volume center (OR: 6.30, 95% CI: 2.29‐17.33, p<0.001), or transfer from an outside hospital (OR: 1.89, 95% CI: 1.42‐2.51, p<0.001). Conversely, there was a lower likelihood of EVT in those with CNS infections (OR: 0.19, 95% CI: 0.07‐0.48, p=0.001), CNS cancer (OR: 0.24, 95% CI: 0.06‐0.93, p=0.039), other types of cancer (OR: 0.47, 95% CI: 0.32‐0.69, p<0.001), and traumatic head injuries (OR: 0.41, 95% CI: 0.25‐0.68, p<0.001). Individuals with Medicare (OR: 0.39, 95% CI: 0.26‐0.59, p<0.001) or Medicaid insurance (OR: 0.70, 95% CI: 0.50‐0.99, p=0.041), were also less likely to undergo EVT. EVT was associated with an increased odds of in‐hospital mortality (OR: 4.01, 95% CI 2.82‐5.68, p<0.001), a relationship that persisted even after multivariable adjustment with model one (adjusted OR: 2.37 95% CI 1.50‐3.74, p<0.001) and model two (adjusted OR: 7.32 95% CI 2.62‐20.5, p<0.001).

Conclusion
We identified specific demographic and clinical factors associated with EVT use in CVT and found EVT use linked to higher mortality. The directionality of this relation is uncertain but could suggest more frequent use of EVT in individuals with very severe clinical presentations. These findings underscore the need for further prospective work to assess which individuals may benefit from therapy, in addition to optimal timing and approaches.