Autor(es):
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 ; Schoenenberger, Silvia ; Nagel, Simon ; Petruzzellis, Marco ; Raposo, Nicolas ; Skjelland, Mona ; Zimatore, Domenico Sergio ; Aaron, Sanjith ; Sanchez van Kammen, Mayte ; de Sousa, Diana Aguiar ; Lindgren, Erik ; Jood, Katarina ; Scutelnic, Adrian ; Heldner, Mirjam R. ; Poli, Sven ; Arauz, Antonio ; Conforto, Adriana B. ; Putaala, Jukka ; Tatlisumak, Turgut ; Arnold, Marcel ; Coutinho, Jonathan M. ; Günther, Albrecht ; Zimmermann, Julian ; Ferro, José
Data: 2023
Identificador Persistente: http://hdl.handle.net/10451/63209
Origem: Repositório da Universidade de Lisboa
Assunto(s): COVID-19; Intracranial thrombosis; Thrombectomy; Thrombocytopenia; Vaccination; Venous thrombosis
Descrição
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.
