Endovascular treatment of cerebral venous sinus thrombosis: A systematic review and meta-analysis of efficacy based on technique

Background Cerebral venous sinus thrombosis (CVST) is rare but potentially life-threatening. Although systemic anticoagulation is the primary treatment, endovascular thrombectomy (EVT) or thrombolysis may be considered for refractory cases. Considering advanced techniques and device technology, we undertook an updated systematic review and meta-analysis to evaluate clinical and radiographic outcomes for treating CVST. Methods We searched PubMed and EMBASE for studies describing CVST patients treated with EVT. Presenting symptoms, procedural details, and clinical and radiographic outcomes were analyzed. Random-effects models were generated to calculate pooled proportions of clinical and radiographic outcome variables. Results We analyzed 26 studies comprising 273 patients (mean age 37 years, 57.7% female). Preprocedural intracranial hemorrhage was present in 167/243 (67.1%) patients. Endovascular thrombectomy techniques included aspiration thrombectomy alone (29.3%), aspiration plus stent retriever (19%), stent retriever alone (12.5%), balloon/catheter maceration (6.6%), and AngioJet rheolytic system (32.6%). Random-effects model indicated that 37% of patients had complete recanalization and 57% had partial recanalization. The model indicated that 79% of patients had a good clinical outcome (modified Rankin Scale score 0–2) at last follow-up. There were no statistically significant differences between modern systems (stent retriever and/or aspiration) and older systems (rheolytic thrombectomy and catheter maceration). Aspiration alone yielded a significantly higher frequency of good clinical outcomes compared with the combined technique (83.8% vs. 61.5%, p = 0.004). Conclusion Endovascular thrombectomy for CVST refractory to systemic anticoagulation achieved high recanalization rates, favorable outcomes, and low procedural complication rates. Modern and older techniques exhibited similar safety and efficacy. These findings support EVT as an effective treatment option.