Neurointervention · IR Playbook

Endovascular Treatment of Cerebral Venous Sinus Thrombosis (EVT for CVST)

Endovascular treatment of cerebral venous sinus thrombosis is catheter-based recanalisation of an occluded dural sinus by aspiration, stent retriever, balloon maceration, rheolytic thrombectomy or catheter-directed thrombolysis, performed through a transvenous route. It works by relieving venous outflow obstruction: occlusion of a dural sinus raises cerebral venous and capillary hydrostatic pressure, producing vasogenic then cytotoxic oedema and venous infarction that crosses arterial territories, while obstruction at the arachnoid granulations simultaneously impairs cerebrospinal fluid absorption and raises intracranial pressure. Because the parenchyma is already congested and frequently haemorrhagic before the case starts, the dominant procedural risk is expansion of intracranial haemorrhage rather than ischaemia. The only randomised trial, TO-ACT, was stopped for futility: at 12 months mRS 0-1 was reached by 67 percent of endovascularly treated patients versus 68 percent of controls, with mortality numerically higher in the intervention arm at 12 percent versus 3 percent. Endovascular treatment is therefore a rescue therapy for deterioration despite adequate anticoagulation, not a first-line alternative to it.

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