Cerebral Venous Sinus Thrombosis: Clinical Outcomes in Medical Management and Mechanical Thrombectomy (P1.206)

Objective: We assessed the clinical outcomes of cerebral venous sinus thrombosis (CVST) patients who underwent mechanical thrombectomy (MT) compared to those treated with anticoagulation (AC) alone. Background: AC is the mainstay treatment for CVST. However, not all patients respond to AC. Patients may benefit from MT, however, there is limited data. Design/Methods: Retrospective analysis of the electronic medical record was performed from January 2012 to July 2017. Those with CVST secondary to infection, trauma, and those without follow-up were excluded. Primary analysis was modified Rankin Score (mRS) within one year. Recanalization was assessed as a secondary outcome. Results: Chart review identified 169 acute CVST patients; 81 were included in the analysis. All were treated with AC. Of these, six underwent MT. Adjusting for age, initial NIH stroke score was higher in the MT group (11 vs 2.5, p = 0.0006). Intracranial hemorrhage was seen at presentation in 67% of the MT group, and 28% of the AC group. Majority of patients with CVST achieved functional independence (85.2% mRS ≤ 2) at follow-up. Patients who presented with an infarction or intracranial hemorrhage had a higher mean mRS at follow-up (infarct 1.9 vs. 0.66, p = 0.034. ICH 2.0 vs. 0.51, p = 0.004). MT group had a higher mean mRS at follow-up (2.7 ± 2.1 vs 0.80 ± 1.5, p = 0.0057). There was no significant difference in recanalization between the two groups. Conclusions: While patients who received MT had a higher mean mRS at follow-up, the initial clinical presentation was worse than those treated with AC alone. The majority of patients achieved functional independence, even with ICH or infarction. MT may be an efficacious therapy in CVST. However, with good clinical outcomes in most patients, it is unclear which patients benefit from MT. Further investigation is ongoing to determine predictors of poor outcomes in CVST. Disclosure: Dr. Vu has nothing to disclose. Dr. Guzik has nothing to disclose. Dr. Neth has nothing to disclose.