Evaluation Of Aspiration Thrombectomy Versus Anticoagulation In A Large Cohort Of Patients With Cerebral Venous Sinus Thrombosis.

Introduction: Cerebral venous sinus thrombosis (CVST) is an uncommon cause of stroke. Studies have assessed the efficacy of aspiration thrombectomy (AT), but have been limited to smaller populations, and AT was often reserved for patients with worsening neurological deterioration, which itself portends a poor prognosis. Purpose: To compare outcomes of AT vs. medical management (MM) in a large referral population without neurological deterioration at a single Comprehensive Stroke Center. Methods: We retrospectively identified patients using ICD-10 codes within our network between 2007-2017. Baseline demographics and clinical data were abstracted. Mann-Whitney U test and chi-square test were used for continuous and categorical variables, respectively. Results: 383 patients were identified, and 99 were excluded due to age <5, cortical vein or cavernous sinus thrombosis, and venous stenosis. 284 were analyzed; 237 in MM and 47 in AT. There was no difference in baseline demographics or imaging modality. AngioJet™ was used in 90% of AT patients. Focal neurological deficit on presentation (57% vs 35%, p = 0.0033) and venous/hemorrhagic infarct on imaging (68% vs 37%, p = 0.001) was more common in AT. More patients received AT if superior sagittal plus any other venous sinus or straight sinus alone was involved (66% vs 32%, p = 0.003). All in AT received anticoagulation; 25 in MM did not due to perceived risks (100% vs 89%, p = 0.0194). MM had a better modified Rankin Score (mRS) at discharge (mRS 0-1: 72% vs 50%, p = 0.0037). There was no difference in mRS at 3, 6 and 12 months, and the development of chronic daily headache, migraine, or epilepsy. Subgroup analysis using those with only superior sagittal plus any other venous sinus or straight sinus alone showed MM had a better mRS at discharge (mRS 0-1: 68% vs 42%, p = 0.014). Conclusion: This study shows that MM was more likely to have a favorable outcome at discharge than AT. No difference in outcome measured at 3, 6 and 12 months was seen.