Endovascular treatment of cerebral sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia.

Weller, Johannes; Krzywicka, Katarzyna; van de Munckhof, Anita; Dorn, Franziska; Althaus, Katharina; Bode, Felix J; Bandettini di Poggio, Monica; Buck, Brian; Kleinig, Timothy; Cordonnier, Charlotte; Dizonno, Vanessa; Duan, Jiangang; Elkady, Ahmed; Chew, Beng Lim Alvin; Garcia-Esperon, Carlos; Field, Thalia S; Legault, Catherine; Morin Martin, Mar; Michalski, Dominik; Pelz, Johann; ... (2024). Endovascular treatment of cerebral sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia. European stroke journal, 9(1), pp. 105-113. Sage 10.1177/23969873231202363

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INTRODUCTION

There is little data on the role of endovascular treatment (EVT) of cerebral venous sinus thrombosis (CVST) due to vaccine-induced immune thrombotic thrombocytopenia (VITT). Here, we describe clinical characteristics and outcomes of CVST-VITT patients who were treated with EVT.

PATIENTS AND METHODS

We report data from an international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 6 March 2023. VITT was defined according to the Pavord criteria.

RESULTS

EVT was performed in 18/136 (13%) patients with CVST-VITT (92% aspiration and/or stent retrieval, 8% local thrombolysis). Most common indications were extensive thrombosis and clinical or radiological deterioration. Compared to non-EVT patients, those receiving EVT had a higher median thrombus load (4.5 vs 3). Following EVT, local blood flow was improved in 83% (10/12, 95% confidence interval [CI] 54-96). One (6%) asymptomatic sinus perforation occurred. Eight (44%) patients treated with EVT also underwent decompressive surgery. Mortality was 50% (9/18, 95% CI 29-71) and 88% (8/9, 95% CI 25-66) of surviving EVT patients achieved functional independence with a modified Rankin Scale score of 0-2 at follow-up. In multivariable analysis, EVT was not associated with increased mortality (adjusted odds ratio, 0.66, 95% CI 0.16-2.58).

DISCUSSION AND CONCLUSION

We describe the largest cohort of CVST-VITT patients receiving EVT. Half of the patients receiving EVT died during hospital admission, but most survivors achieved functional independence.

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