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2017 ; 8
(2
): 136-148
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New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous
Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments
#MMPMID28400981
Konakondla S
; Schirmer CM
; Li F
; Geng X
; Ding Y
Aging Dis
2017[Apr]; 8
(2
): 136-148
PMID28400981
show ga
Dural venous sinus thrombosis (DVST) is a rare cause of stroke, which typically
affects young women. The importance of identifying pre-disposing factors that
lead to venous stasis lies in the foundation of understanding the etiology,
pathophysiology and clinical presentation. The precise therapeutic role of
interventional therapies is not fully understood though the current data do
suggest potential applications. The aim of the study was to perform a systematic
review and meta-analysis to evaluate the utility of and short-term 30-day
survival after endovascular therapy for patients with DVST. Standard PRISMA
guidelines were followed. Data sources included PubMed keywords and phrases,
which were also incorporated into a MeSH search to yield articles indexed in
Medline over a 5-year period. All RCTs, observational cohort studies, and
administrative registries comparing or reporting DVST were included. Sixty-six
studies met inclusion criteria. 35 articles investigating treatment in a
summation of 10,285 patients were eligible for data extraction and included in
the review of treatment modalities. A total of 312 patients were included for
statistical analysis. All patients included received endovascular intervention
with direct thrombolysis, mechanical thrombectomy or both. 133 (42.6%) patients
were documented to have a neurologic decline, which prompted endovascular
intervention. All patients who had endovascular interventions were those who were
started on and failed systemic anticoagulation. 44 patients were reported to have
intracranial hemorrhages after intervention. Regardless of systemic
anticoagulation, patients were still reported to have complications of VTE and
PE. Primary outcome at 3-6 month follow up revealed mRS<1 in 224 patients. DVST
presents with many diagnostic and therapeutic challenges. The utility of invasive
interventions such as local thrombolysis and mechanical thrombectomy is not fully
understood. It is exceedingly difficult to conduct large randomized trials for
this low incidence disease process with large pathophysiological heterogeneity.