TY - JOUR
T1 - International practice patterns and perspectives on endovascular therapy for the treatment of cerebral venous thrombosis
AU - Brakel, Benjamin A.
AU - Rebchuk, Alexander D.
AU - Ospel, Johanna
AU - Chen, Yimin
AU - Heran, Manraj K.S.
AU - Goyal, Mayank
AU - Hill, Michael D.
AU - Miao, Zhongrong
AU - Huo, Xiaochuan
AU - Sacco, Simona
AU - Yaghi, Shadi
AU - Mai, Ton Duy
AU - Thomalla, Götz
AU - Boulouis, Grégoire
AU - Yamagami, Hiroshi
AU - Hu, Wei
AU - Nagel, Simon
AU - Puetz, Volker
AU - Kristoffersen, Espen Saxhaug
AU - Demeestere, Jelle
AU - Qiu, Zhongming
AU - Abdalkader, Mohamad
AU - Al Kasab, Sami
AU - Siegler, James E.
AU - Strbian, Daniel
AU - Fischer, Urs
AU - Coutinho, Jonathan
AU - Munckhof, Anita
AU - Aguiar de Sousa, Diana
AU - Campbell, Bruce C.V.
AU - Raymond, Jean
AU - Ji, Xunming
AU - Saposnik, Gustavo
AU - Nguyen, Thanh N.
AU - Field, Thalia S.
N1 - Publisher Copyright:
© 2024 World Stroke Organization.
PY - 2025/3
Y1 - 2025/3
N2 - 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.
AB - 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.
KW - Stroke
KW - anticoagulants
KW - endovascular procedures
KW - thrombectomy
KW - venous thrombosis
UR - https://www.scopus.com/pages/publications/85212235452
U2 - 10.1177/17474930241304206
DO - 10.1177/17474930241304206
M3 - Artículo
C2 - 39569543
AN - SCOPUS:85212235452
SN - 1747-4930
VL - 20
SP - 319
EP - 327
JO - International Journal of Stroke
JF - International Journal of Stroke
IS - 3
ER -