Introduction Cerebral sinus thrombosis (CVT) is an overall uncommon cause of cerebral venous infarction that accounts for approximately 0.5–1% of all strokes. The initial treatment for CVT is systemic anticoagulation, which has been associated with improved neurological outcomes in small randomized studies. However, with anticoagulation alone, large and extensive thrombi are unlikely to dissolve, and thus approximately one-third of patients with severe presentation have a high risk of incomplete recovery. Endovascular intervention is an alternative option for patients with neurological deterioration despite the use of anticoagulation or with the development of new or worsening intracerebral hemorrhage (ICH) on anticoagulation. Current endovascular techniques include direct catheter thrombolysis, balloon-assisted thrombectomy, rheolytic catheter thrombectomy, aspiration thrombectomy, and stent retriever thrombectomy. Prior studies have reported a higher risk of mortality and poor outcomes in the EVT group. However, there is a lack of contemporary data regarding sex-based differences in outcomes. The goal of our study was to understand the sex-based trend of EVT utilization and differences in outcomes following CVT.
Methods We used the Nationwide Inpatient Sample database from the year 2005–2015 to identify CVT hospitalizations who treated with EVT using ICD-9 CM code. To make the data nationally representative, weights were applied as per NIS recommendations. Chi-square test and student’s T-test were used for categorical and continuous variables to analyze descriptive data, respectively. A multivariate logistic regression model was performed on outcomes variables (discharge to home and in-hospital mortality) to avoid confounding effects.
Result A total of 46,537 CVT were extracted from the years 2005–2015. Among them, 2,065 treated with EVT (female N=1,384 and male N=681). The mean age of the EVT treated group was male 48.7±1.38 vs. female 43.0±1.05 (p=0.002). While in medically treated group mean age was male 49.5±0.38 vs. female 40.6±0.26 (p<0.001). After adjusting comorbidities, multivariable models did not show a statistical difference in mortality and home discharge among medically, and EVT treated gender groups (table). The overall trend of EVT utilization was increased from 29 cases in 2005 to 57 cases in 2015 per 1000 CVT hospitalization (trend p=0.04). EVT in female group trended up (26 cases in 2005 to 57 cases in 2015; p=0.04) while in male, EVT cases also trending up; however, without attaining statistical significance (p=0.45).
Conclusion Our nationally represented sample showed no difference in outcomes in medically, and EVT treated groups among gender despite prior literature suggesting poor outcomes in the EVT group. Patient selection for EVT should be individualized based on patient presentation. Our analysis showed CVT treated with EVT hospitalization is trending up in the US.
Disclosures S. Patel: None. N. Desai: None. M. Pervez: None.
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