Safety and efficacy of endovascular thrombectomy in patients with severe cerebral venous thrombosis: A meta-analysis

Gaurav Nepal; Sanjeev Kharel; Riwaj Bhagat; Megan A Coghlan; Jayant K Yadav; Stella Goeschl; Rajan Lamichhane; Subash Phuyal; Rajeev Ojha; Gentle S Shrestha

doi:10.1177/11795735221131736

Safety and efficacy of endovascular thrombectomy in patients with severe cerebral venous thrombosis: A meta-analysis

J Cent Nerv Syst Dis. 2022 Oct 2:14:11795735221131736. doi: 10.1177/11795735221131736. eCollection 2022.

Authors

Affiliations

¹ Department of Internal Medicine, Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Maharajgunj, Nepal.
² Department of Neurology, Boston University Medical Center, Boston, MA, USA.
³ Department of Neurology, University of Louisville School of Medicine, Louisville, KY, USA.
⁴ Department of Neurology, Medical University of Vienna, Vienna, Austria.
⁵ Department of Neuroimaging and Interventional Neuroradiology, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences, Bansbari, Nepal.
⁶ Department of Neurology, Tribhuvan University Teaching Hospital, Maharajgunj, Nepal.
⁷ Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Nepal.

Abstract

Background: Cerebral venous thrombosis (CVT) is a rare thrombotic condition which is traditionally treated with anti-coagulation therapy. Subsets of patients with severe CVT have been treated with endovascular thrombectomy (EVT). Despite the high estimated mortality associated with severe CVT, there has been only one randomized control trial done regarding safety and efficacy of EVT in severe CVT compared to standard medical management. Evidence in this area is lacking.

Objective: The aim of this systematic review is to analyze all existing literature and generate robust information regarding the role of EVT in the management of patients with severe CVT.

Methods: This systematic review and meta-analysis followed PRISMA guideline. PubMed, Embase, Google Scholar, and CNKI were searched for eligible studies from 2007 to 2021. Safety and efficacy of EVT were evaluated by meta-analyzing recanalization status, the good functional outcome at follow-up, recurrent CVT, new hematoma. A pooled proportion with a 95% confidence interval was derived from a meta-analysis of various outcomes (CI).

Results: A total of 33 studies comprising 610 patients treated with EVT were included for analysis which comprised one randomized control trial, one prospective study and 31 retrospective studies. Based on pooled data, 85% of patients had good functional outcome, 62% had complete recanalization, 5% had all-cause mortality, and 3% had catheter related complications. The efficacy outcomes in this analysis had a significant heterogeneity and a subgroup analysis was also done to explain these findings. The minimum time of follow up was 3 months and varied EVT techniques were used across the studies.

Conclusion: This meta-analysis suggests EVT may be safe and efficacious in treating patients with severe CVT.

Registration: Our protocol was registered with PROSPERO: International prospective register of systematic reviews with the registration number CRD42021254760.

Keywords: CVST; Cerebral venous thrombosis; cerebral venous sinus thrombosis; cerebral venous thrombosis; endovascular thrombectomy; mechanical thrombectomy.