Efficacy of stenting in patients with cerebral venous sinus thrombosis-related cerebral venous sinus stenosis

BackgroundVenous stenting has been proven to be a safe and effective therapeutic option for patients with idiopathic intracranial hypertension (IIH) and cerebral venous sinus stenosis (CVSS). However, its use in patients with cerebral venous sinus thrombosis-related CVSS has been less reported.PurposeTo explore the safety and efficacy of stenting for patients with cerebral venous sinus thrombosis (CVST)-related CVSS.MethodsThe clinical presentation, treatment, and outcome of patients with CVST-related CVSS received venous stenting in the chronic stage after failed medical treatment were retrospectively evaluated.ResultsA total of 17 patients with CVST-related CVSS were included. Mean pressure gradient across the CVSS decreased from 11.5±4.2 mmHg prior to stenting to 2.1±1.1 mmHg post- stenting. Mean CSF opening pressure decreased from 33.1±5.5 cmH2O to 18.7±1.7 cmH2O. Both headache and visual disturbance improved or resolved in 78% and 92% of the patients, respectively. Complications included lethal cerebellar hematoma in one case and bilateral occipital epidural hematoma in another case. One of the patients received retreatment with ventriculo-peritoneal shunting due to recurrent headache.ConclusionRestoring the patency of stenotic sinuses with stents in patients of CVST-related CVSS unresponsive to medical therapy in the chronic stage may improve symptoms in the majority of the patients. However, a relatively higher cerebral hemorrhage rate was observed and may be related to this pathology. Stenting in this subgroup of CVSS patients may require further evaluation with a larger and long-term study, and should be used with caution at this time.

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T1-weighted Black-blood Magnetic Resonance Imaging Helps to Stage Thrombus on Segment Level and Predict the Outcome of Endovascular Therapy in Patients with Cerebral Venous Sinus Thrombosis

10.21203/rs.3.rs-847671/v1 ◽

2021 ◽

Author(s):

Yanan Ren ◽

Tao Quan ◽

Yueyuan Xie ◽

Qi Ren ◽

Xiaoyong Zhang ◽

...

Keyword(s):

Endovascular Therapy ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Therapy Outcome ◽

Black Blood ◽

Clinical Approach ◽

Chronic Stage ◽

Venous Sinus Thrombosis ◽

Signal Characteristics

Abstract Purpose Clinical approach for staging cerebral venous sinus thrombosis (CVST) depends on the duration from symptom onset to clinical diagnosis, which is subjective and may be incorrect. To investigate if T1-weighted signal characteristics of the thrombus can be used for staging the thrombus on segment level and predicting endovascular therapy outcome. Methods Ninety-one CVST patients underwent non-contrast-enhanced T1-weighted 3D variable-flip-angle fast-spin-echo (T1-SPACE) and 29 of them received endovascular therapy. We divided the 91 patients into acute, subacute, and chronic CVST stage according to the clinical approach, and then analyzed the T1 weighted signal characteristics (i.e., thrombus shape and signal intensity) of the thrombus at each stage. To investigate the endovascular therapy outcome associated with the thrombus stage and signal characteristics, we evaluated the thrombolytic ratio on patient level and recanalization rate on segment level, respectively. Results The thrombi at acute or chronic stage were depicted as isointense signals but as hyperintense signals at subacute stage. Compared to the thrombus at acute stage, the thrombus at chronic stage was contractive and can be distinguished. Developing thrombi at transition periods of acute-to-subacute or subacute-to-chronic stage were found appearing mixed iso-/hyper-intense signals. On patient’s level, the patients at earlier stage had higher thrombolytic ratio (acute: 80.7 ± 18.3%, subacute: 62.6 ± 36.3%, chronic: 22.9 ± 24.2%). On segment level, the thromboembolic segments of isointense or mixed iso-/hyper-intense thrombi at non-chronic stage had good thrombolytic outcome. Conclusion T1-weighted signal characteristics of the thrombus can be used for staging CVST and predicting the endovascular therapy outcome.

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