International practice patterns and perspectives on endovascular therapy for the treatment of cerebral venous thrombosis

Benjamin A Brakel; Alexander D Rebchuk; Johanna Ospel; Yimin Chen; Manraj Ks Heran; Mayank Goyal; Michael D Hill; Zhongrong Miao; Xiaochuan Huo; Simona Sacco; Shadi Yaghi; Ton Duy Mai; Götz Thomalla; Grégoire Boulouis; Hiroshi Yamagami; Wei Hu; Simon Nagel; Volker Puetz; Espen Saxhaug Kristoffersen; Jelle Demeestere; Zhongming Qiu; Mohamad Abdalkader; Sami Al Kasab; James E Siegler; Daniel Strbian; Urs Fischer; Jonathan Coutinho; Anita Munckhof; Diana Aguiar de Sousa; Bruce Cv Campbell; Jean Raymond; Xunming Ji; Gustavo Saposnik; Thanh N Nguyen; Thalia S Field

doi:10.1177/17474930241304206

International practice patterns and perspectives on endovascular therapy for the treatment of cerebral venous thrombosis

Int J Stroke. 2024 Dec 17:17474930241304206. doi: 10.1177/17474930241304206. Online ahead of print.

Authors

Benjamin A Brakel¹, Alexander D Rebchuk², Johanna Ospel^{3

4}, Yimin Chen⁵, Manraj Ks Heran⁶, Mayank Goyal^{3

4}, Michael D Hill^{3

4}, Zhongrong Miao⁷, Xiaochuan Huo⁸, Simona Sacco⁹, Shadi Yaghi¹⁰, Ton Duy Mai^{11

12}, Götz Thomalla¹³, Grégoire Boulouis¹⁴, Hiroshi Yamagami¹⁵, Wei Hu¹⁶, Simon Nagel¹⁷, Volker Puetz^{18

19}, Espen Saxhaug Kristoffersen²⁰, Jelle Demeestere²¹, Zhongming Qiu²², Mohamad Abdalkader²³, Sami Al Kasab²⁴, James E Siegler²⁵, Daniel Strbian²⁶, Urs Fischer²⁷, Jonathan Coutinho²⁸, Anita Munckhof²⁸, Diana Aguiar de Sousa^{29

30}, Bruce Cv Campbell³¹, Jean Raymond³², Xunming Ji³³, Gustavo Saposnik³⁴, Thanh N Nguyen²³, Thalia S Field³⁵

Affiliations

¹ Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
² Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
³ Department of Radiology, University of Calgary, Calgary, AB, Canada.
⁴ Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
⁵ Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
⁶ Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
⁷ Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁸ Neurological Disease Center, Beijing Anzhen Hospital, Beijing, China.
⁹ Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
¹⁰ Department of Neurology, Brown University, Providence, RI, USA.
¹¹ Stroke Centre, Bach Mai Hospital, Ha Noi Medical University, Hanoi, Vietnam.
¹² VNU University of Medicine and Pharmacy, Hanoi, Vietnam.
¹³ Department of Neurology, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany.
¹⁴ Departments of Diagnostic and Interventional Neuroradiology, University of Tours, Tours, France.
¹⁵ Department of Stroke Neurology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
¹⁶ Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China.
¹⁷ Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen, Germany.
¹⁸ Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany.
¹⁹ Dresden Neurovascular Center, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany.
²⁰ Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
²¹ Department of Neurology, Leuven University Hospital, Leuven, Belgium.
²² Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army, Hangzhou, China.
²³ Department of Neurology, Radiology, Boston University School of Medicine, Boston, MA, USA.
²⁴ Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
²⁵ Department of Neurology, University of Chicago, Chicago, IL, USA.
²⁶ Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
²⁷ Department of Neurology, University Hospital Bern, University of Bern, Bern, Switzerland.
²⁸ Department of Neurology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
²⁹ Stroke center, Lisbon Central University Hospital-ULS S José, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
³⁰ L Lopes lab, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal.
³¹ Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.
³² Department of Radiology, Service of Interventional Neuroradiology, Université de Montréal, Montreal, QC, Canada.
³³ Department of Neurosurgery, Xuanwu Hospital, Beijing, China.
³⁴ Stroke Outcomes Research & Decision Neuroscience Unit, Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
³⁵ Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.

PMID: 39569543
DOI: 10.1177/17474930241304206

Abstract

Background: Cerebral venous thrombosis (CVT) accounts for 0.5-1% of all strokes. The role of endovascular therapy (EVT) in the management of CVT remains controversial and variations in practice patterns are not well known.

Aims: Here, we present a comprehensive, international characterization of practice patterns and perspectives on the use of EVT for CVT.

Methods: A comprehensive 42-question survey was distributed to stroke clinicians globally from May to October 2023, asking about practice patterns and perspectives on the use of EVT for CVT.

Results: The overall response rate was 31% (863 respondents of 2744 invited) across 61 countries. The majority of respondents (74%) supported the use of EVT for CVT in certain clinical situations. Key considerations for decision-making in using EVT favored clinical over radiographic/procedural factors and included worsening level of consciousness (86%) and worsening neurological deficits (76%). In the past 3 years, 56% of respondents used EVT for the treatment of CVT, with most (49.5%) involved in two to five cases. Among interventionalists, significant variability existed in the techniques used for EVT (p < 0.001), with aspiration thrombectomy (56%) and stent retriever (51%) being the most used overall. Regionally, interventionalists from China predominantly used intra-sinus heparin (56%), while this technique was most commonly ranked as "never indicated" throughout the rest of the world (23%). Post-procedure, low molecular weight heparin was the most used anticoagulant (83%), although North American respondents favored unfractionated heparin (37%), while imaging was primarily split between magnetic resonance (71.8%) and computed tomography (65.9%) arteriography or venography.

Conclusion: Our survey reveals significant heterogeneity in approaches to EVT for CVT, and provides a comprehensive characterization of indications, techniques, and long-term management used by clinicians internationally. This resource will aid in optimizing patient selection and endovascular treatments for future trials.

Keywords: Stroke; anticoagulants; endovascular procedures; thrombectomy; venous thrombosis.