Transvenous Endovascular Recanalization for Cerebral Venous Thrombosis: A Systematic Review and Meta-Analysis.

Abstract

In patients who have failed systemic anticoagulation therapy, various endovascular approaches may assist in emergent recanalization. We searched the PubMed database from January 1999 to August 2018 for studies that reported endovascular treatment modalities and associated clinical outcomes including recanalization, functional independence, mortality, or intracranial complications. Random-effect models were used to pool estimates across studies using R software. Overall, 393 patients with cerebral venous thrombosis from 21 studies were included in the study. Transvenous local chemolysis treatment results were as follows: good outcome rate. 0.88 (95% confidence interval [CI], 0.80-0.93), mortality, 0.08 (95% CI, 0.04-0.16), postprocedural hemorrhagic rate, 0.11 (95% CI, 0.06-0.19), and complete recanalization rate, 0.59 (95% CI, 0.48-0.70). Transvenous mechanical thrombectomy results were as follows: good outcome rate, 0.66 (95% CI, 0.41-0.84), mortality, 0.09 (95% CI, 0.03-0.26), postprocedural hemorrhagic rate, 0.03 (95% CI, 0-0.16), and complete recanalization rate, 0.60 (95% CI, 0.35-0.80). Combined approach treatment results were as follows: good outcome rate, 0.80 (95% CI, 0.70-0.87), mortality, 0.10 (0.04-0.22), postprocedural hemorrhagic rate, 0.17 (95% CI, 0.10-0.27), and complete recanalization rate, 0.75 (95% CI, 0.64-0.84). Mixed approach to treatment results were as follows: good outcome rate, 0.61 (95% CI, 0.51-0.70), mortality, 0.23 (95% CI, 0.16-0.32), postprocedural hemorrhagic rate, 0.46 (95% CI, 0.33-0.59), and complete recanalization rate, 0.48 (95% CI, 0.37-0.58). The combination approach treatment tended to have better outcomes, although this meta-analysis did not achieve statistical significance in all outcome parameters. Future studies are needed to establish the best treatment options with tailoring to specific clinical or angiographic scenarios.