Dr. Philipp Bücke (Bern / CH), Professor Hans Henkes (Stuttgart / DE), Dr. Alexandru Cimpoca (Stuttgart / DE), Dr. Thomas Horvath (Bern / CH), Dr. Elina Henkes (Stuttgart / DE), Professor Hansjörg Bäzner (Stuttgart / DE), Dr. Victoria Hellstern (Stuttgart / DE)
Abstract-Text (inkl. Referenzen und Bildunterschriften)
Background and Purpose: Endovascular therapy (EVT) for severe intracranial venous sinus thrombosis (CVST) is controversial in terms of indication and clinical benefit. So far, a potential effect of time and timing of EVT in these patients has been neglected. We aimed to investigate the effect of early versus late initiation of EVT in severe CVST.
Methods: From our prospective single-center EVT registry, CVST patients were identified (January 2010 to October 2022). EVT was performed in severe CVST with features prone to a poor prognosis. Based on the time between emergency consultation and EVT, we compared early (< 24 hours) versus late (> 24 hours) initiation of EVT. The main outcome parameter was mortality at three months. Secondary outcome parameters included excellent functional outcome (modified Rankin Scale [mRS] scores 0-1) and functional independence (mRS scores 0-2) at 90 days.
Results: Out of 177 CVST patients, 36 (20.3%; 24 [early EVT] versus 12 [late EVT]) could be analyzed. Our results revealed a substantial reduction in mortality at three months among early versus late EVT (12.5% versus 44.4%; odds ratio [OR] 5.6; 95% confidence interval [CI] 0.81-38.79; p = 0.068). 58.3% versus 22.2% of patients exhibited excellent functional outcomes (mRS 0-1; OR 0.20; 95% CI 0.03-1.36; p = 0.118) at 90 days.
Conclusions: While not achieving statistical significance, we observed a potentially clinically relevant reduction in mortality and an increase in functional outcomes in early EVT. Sufficiently-powered randomized-controlled trials need to confirm these findings and evaluate a time-is-brain paradigm for EVT in CVST.