Endovascular Intervention for Refractory Pediatric Cerebral Venous Sinus Thrombosis

Nisha Gadgil, Guillermo Aldave, William E. Whitehead, Adam A. Dmytriw, Karen Chen, Darren Orbach, Ilko Maier, Daniel Behme, Kyle M. Fargen, Lucas Elijovich, David Dornbos, Alejandro Spiotta, Peter Kan

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Cerebral venous sinus thrombosis (CVST) is a rare but potentially morbid disease in the pediatric population, and the optimal treatment is not fully understood. Endovascular intervention for this condition has been rarely reported. Methods: The Stroke Thrombectomy and Aneurysm Registry was queried for patients aged less than or equal to 18 years undergoing endovascular treatment for CVST in the past 10 years. Clinical charts and radiographic data were retrospectively reviewed. Modified Rankin Score (mRS) at 90 days postprocedure was determined as the primary outcome. Results: A total of seven patients across five pediatric centers ranging from 7 to 16 years of age were identified with a mean follow-up of 28 months. All had underlying conditions predisposing to CVST. Endovascular intervention was undertaken due to neurological deterioration despite systemic anticoagulation; venous infarct was evident preoperatively in six of seven patients. Mechanical venous thrombectomy was attempted in all individuals, and intrasinus thrombolytic therapy was also performed in three cases. Six patients had favorable outcome with mRS 0 or 1 at 90 days postprocedure; one remained neurologically devastated. Conclusions: Endovascular treatment by an experienced interventionalist may be safe and effective in severe cases of CVST in children failing frontline therapy. Children with radiographic or clinical progression despite anticoagulation may be considered for endovascular intervention in a timely manner.

Original languageEnglish (US)
Pages (from-to)45-50
Number of pages6
JournalPediatric Neurology
Volume121
DOIs
StatePublished - Aug 2021

Keywords

  • Pediatric
  • Thrombectomy
  • Venous infarction
  • Venous sinus thrombosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Neurology
  • Developmental Neuroscience
  • Clinical Neurology

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