Frequency and temporal profile of recanalization after cerebral vein and sinus thrombosis

Eur J Neurol. 2016 Apr;23(4):681-7. doi: 10.1111/ene.12901. Epub 2015 Nov 19.

Abstract

Background and purpose: The temporal course of recanalization and its association with clinical outcome were analysed in our patients with cerebral sinus and/or venous thrombosis (CSVT) and follow-up magnetic resonance imaging (MRI).

Methods: Between January 1998 and September 2014 all patients from our institutions with CSVT were systematically analysed. Baseline data, treatment characteristics and follow-up MRI were retrospectively recorded. The status of recanalization was assessed as complete (CRec), partial (PRec) or failed recanalization. Clinical follow-up was measured with the modified Rankin Scale. Excellent outcome was defined as modified Rankin Scale 0-1.

Results: Ninety-nine patients were identified; 97% of these patients were treated with oral anticoagulation (OAC) and the median (min-max) time of OAC was 7 months (1-84). CRec was achieved in 57.6% (57/99), PRec in 29.3% (29/99) and only 13 (13.1%) patients did not recanalize. The median (min-max) time to PRec was 4 months (0.25-14) and to CRec 6 months (2-34). Median time to last clinical follow-up was 8 months (1-88); 91.8% (89/99) had an excellent outcome at last clinical follow-up and only 2.1% (2/99) died. Only thrombosis of the superior sagittal sinus was independently associated with successful recanalization (odds ratio 16, 95% confidence interval 2-138). No severe haemorrhagic complications and no recurrence of CSVT occurred within clinical follow-up. No association of outcome and recanalization status was found.

Conclusions: The recanalization rate of CSVT under OAC was high and the median time to CRec was 6 months. Thrombosis of the superior sagittal sinus is a positive predictor of recanalization. Outcome in this cohort was excellent but no significant association of outcome and recanalization status was found.

Keywords: anticoagulation; cerebral sinus and venous thrombosis; recanalization.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anticoagulants / therapeutic use*
  • Cerebral Veins / diagnostic imaging
  • Cerebral Veins / pathology*
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Thrombosis / diagnostic imaging
  • Intracranial Thrombosis / drug therapy
  • Intracranial Thrombosis / therapy*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care*
  • Sinus Thrombosis, Intracranial / diagnostic imaging
  • Sinus Thrombosis, Intracranial / therapy

Substances

  • Anticoagulants