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SNIS 21st annual meeting electronic poster abstracts
E-033 Current international practice patterns in endovascular techniques used in the treatment of cerebral venous thrombosis
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  1. A Rebchuk1,
  2. B Brakel2,
  3. J Ospel3,
  4. Y Chen4,
  5. M Heran2,
  6. M Goyal3,
  7. M Hill3,
  8. Z Miao5,
  9. X Huo6,
  10. Y Chen7,
  11. S Sacco8,
  12. S Yaghi9,
  13. M Ton10,
  14. G Thomalla11,
  15. G Boulouis12,
  16. H Yamagami13,
  17. W Hu14,
  18. S Nagel15,
  19. V Puetz16,
  20. E Kristoffersen17,
  21. J Demeestere18,
  22. Z Qiu19,
  23. M Abdalkader20,
  24. S Al Kasab21,
  25. J Siegler22,
  26. D Strbian23,
  27. U Fischer24,
  28. J Coutinho25,
  29. A Munckhof25,
  30. D de Sousa26,
  31. B Campbell27,
  32. J Raymond28,
  33. X Ji29,
  34. G Saposnik30,
  35. T Nguyen20,
  36. T Field31
  1. 1Division of Neurosurgery, University of British Columbia, Vancouver, BC, Canada
  2. 2University of British Columbia, Vancouver, BC, Canada
  3. 3University of Calgary, Calgary, AB, Canada
  4. 4Foshan Sanshui District People’s Hospital, Foshan, China
  5. 5Capital Medical University, Beijing, China
  6. 6Beijing Tiantan Hospital, Beijing, China
  7. 7National Taiwan University, Taipei City, Taiwan
  8. 8University of L’Aquila, L’Aquila, Italy
  9. 9Brown University, Providence, RI
  10. 10Hanoi Medical University, Hanoi, Vietnam
  11. 11University of Hamburg, Hamburg, Germany
  12. 12University of Tours, Tours, France
  13. 13University of Tsukuba, Tsukuba, Japan
  14. 14The First Affiliated Hospital of University of Science and Technology of China, Anhui, China
  15. 15Klinikum Ludwigshafen, Ludwigshafen, Germany
  16. 16Technische Universität Dresden, Dresden, Germany
  17. 17Akershus University Hospital, Lørenskog, Norway
  18. 18Leuven University Hospital, Leuven, Belgium
  19. 19The 903rd Hospital of The Chinese People’s Liberation Army, Hangzhou, China
  20. 20Boston University School of Medicine, Boston, MA
  21. 21Medical University of South Carolina, Charleston, SC
  22. 22University of Chicago, Chicago, IL
  23. 23Helsinki University Hospital, Helsinki, Finland
  24. 24University Hospital Basel, Basel, Switzerland
  25. 25, University of Amsterdam, Amsterdam, Netherlands
  26. 26University of Lisbon, Lisbon, Spain
  27. 27University of Melbourne, Melbourne, Australia
  28. 28Université de Montréal, Montréal, QC, Canada
  29. 29Xuanwu Hospital, Beijing, China
  30. 30University of Toronto, Toronto, ON, Canada
  31. 31Division of Neurology, University of British Columbia, Vancouver, BC, Canada

Abstract

Introduction Cerebral venous thrombosis (CVT) accounts for approximately 0.5–1% of all strokes. Current treatment for CVT is consensus guided, with unfractionated or low-molecular-weight heparin recommended in the acute management. The role of endovascular therapy (EVT) is less well-defined. A randomized trial, TO-ACT, and a propensity score analysis from the ACTION-CVT trial did not demonstrate a survival or functional benefit for EVT in CVT. Decision-making around EVT in the treatment of CVT remains case-by-case and current practice patterns are not well known. Therefore, we sought to characterize current international practice patterns for EVT in CVT, and explore regional variability.

Methods A comprehensive survey was distributed to stroke physicians, interventional neurologists, interventional neuroradiologists, and endovascular neurosurgeons through local networks and professional societies in 2023. The 53-question survey asked about practice patterns and EVT techniques used in the management of CVT.

Results Overall, 863 physicians completed the survey with a response rate of 31.4%. Herein, we present data from the 299 neurointerventionalists respondents comprising 158 (52.8%) interventional neurologists, 97 (32.4%) interventional neuroradiologists, 28 (9.4%) endovascular neurosurgeons, and 16 (5.4%) interventional radiologists completed the survey. Respondents were predominantly male (82.6%) and practicing in an academic hospital with a comprehensive stroke center (73.6%). Respondents practiced in North America (12.7%), Asia (58.9%), Europe (25.1%), South America (1.7%), Africa (1.0%) and Oceania (0.7%). In the past three years, 61.9% of respondents performed EVT for the treatment of CVT. Most respondents had performed 2 to 5 cases (51.9%), while only 8.6% had performed more than 10 cases in the past three years. The majority of respondents (85.6%) felt the superficial dural sinuses were amenable to intervention, 34.1% felt the deep venous sinuses were amenable and 9.4% perceived the superficial cortical veins were amenable. Mechanical thrombectomy with aspiration was the most utilized technique with 56.2% of respondents using it in the past three years. The other most utilized techniques were mechanical thrombectomy with stent retriever (50.5%), direct thrombolysis with tissue plasminogen activator (33.4%), direct administration of heparin (32.8%) and balloon angioplasty (23.4%). There was significant regional variability in the EVT techniques used (p<0.001). Direct administration of heparin was more common in Asia, with 46.6% respondents in Asia reporting its use in the past three years. Mechanical thrombectomy with stent retriever or aspiration, and thrombus maceration with wire, were used less commonly in Asia compared to North American and European neurointerventionalists.

Eighty percent of neurointerventionalists agreed that in certain situations, EVT was superior to standard medical management of CVT, and 72.6% supported future trials of EVT in the management of CVT.

Conclusions In our international survey, more than half of neurointerventionalists have treated CVT with endovascular therapy in the past three years. Mechanical thrombectomy with aspiration or stent retriever are the most commonly used techniques, however, there is regional variability. Overall, the use of endovascular therapy in the management of CVT is rare. These data may inform the design of future clinical trials to guide practice.

Disclosures A. Rebchuk: None. B. Brakel: None. J. Ospel: None. Y. Chen: None. M. Heran: None. M. Goyal: None. M. Hill: None. Z. Miao: None. X. Huo: None. Y. Chen: None. S. Sacco: None. S. Yaghi: None. M. Ton: None. G. Thomalla: 2; C; Acandis, Alexion, Amarin, Astra Zeneca, Bayer, Boehringer Igelheim, BristolMyersSquibb/Pfizer, Daiichi Sanyo, Stryker. G. Boulouis: None. H. Yamagami: 1; C; Bristol-Myers Squibb. 3; C; Stryker, Medtronic, J&J, Bayer, Daiichi Sankyo, Bristol-Myers Squibb, Otuska Pharmaceutical. W. Hu: None. S. Nagel: 2; C; Brainomix. 3; C; Boehringer Ingelheim, Pfizer. V. Puetz: None. E. Kristoffersen: None. J. Demeestere: None. Z. Qiu: None. M. Abdalkader: None. S. Al Kasab: None. J. Siegler: 1; C; National Institutes of Health (R61NS135583). 2; C; AstraZeneca. 6; C; Philips, Viz.ai, Philips, Medtronic. D. Strbian: 1; C; Boehringer Ingelheim. 2; C; Orion, Herantis Pharma, CSL Behring. 6; C; Boehringer Ingelheim, Alexion/Astra Zeneca, BMS/Janssen. U. Fischer: 1; C; Medtronic, Stryker, Rapid medical, Penumbra, Boehringer Ingelheim. 2; C; Medtronic, Stryker, CSL Behring. 3; C; Alexion/Portola, Boehringer Ingelheim, Biogen, Acthera. J. Coutinho: 1; C; Bayer, Astrazeneca. 4; C; TrianecT. A. Munckhof: None. D. de Sousa: None. B. Campbell: None. J. Raymond: None. X. Ji: None. G. Saposnik: None. T. Nguyen: 2; C; Brainomix. T. Field: None.

https://doi.org/10.1136/jnis-2024-SNIS.138

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