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Standards
Current endovascular strategies for cerebral venous thrombosis: report of the SNIS Standards and Guidelines Committee
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  1. Seon-Kyu Lee1,
  2. Maxim Mokin2,
  3. Steven W Hetts3,
  4. Johanna T Fifi4,
  5. Marie-Germaine Bousser5,
  6. Justin F Fraser6
  7. on behalf of the Society of NeuroInterventional Surgery
    1. 1 Department of Radiology, The University of Chicago, Chicago, Illinois, USA
    2. 2 Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
    3. 3 Department of Radiology, UCSF, San Francisco, California, USA
    4. 4 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
    5. 5 Service de Neurologie, Hopital Lariboisiere, Paris, Île-de-France, France
    6. 6 Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
    1. Correspondence to Dr Justin F Fraser, Departments of Neurological Surgery, Neurology, Radiology and Neuroscience, University of Kentucky, Lexington KY 40536, USA; Jfr235{at}uky.edu

    https://doi.org/10.1136/neurintsurg-2018-013973

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      Introduction

      Cerebral venous thrombosis (CVT) is a rare condition accounting for <1% of all strokes, with highly variable clinical presentations ranging from a headache to coma.1–4 Although MRI and MR venography have significantly improved early diagnosis, clinical outcomes after treatment remain mixed.5 6

      The aims of this document include: (1) to review existing knowledge about the natural history, diagnostic methodology, and treatment modalities/techniques for CVT, and (2) to provide recommendations on management strategies for CVT using the best available evidence, but out of necessity, frequently relying on expert opinion concerning this rare disease. Recommendations follow the American College of Cardiology/American Heart Association (ACC/AHA) classification of recommendation/level of evidence and definition of classes and levels of evidence used in AHA/American Stroke Association (ASA) recommendations.7

      Literature search

      The Standards and Guidelines Committee of the Society of Neurointerventional Surgery (SNIS), a multidisciplinary society representing leaders in the field of endovascular therapy for neurovascular disease, prepared this document based on a comprehensive review of English language literature relating to the topic. A literature search using PubMed (US National Library of Medicine) and Ovid (Wolters Kluwer) databases was performed from January 1, 1980, through December 31, 2016. The following key words were used: [(sinus thrombosis) AND ((cerebral veins) OR (cranial sinuses) OR (heparin) OR (thrombectomy) OR (anticoagulation))]. A review of references provided in review articles and textbook chapters was also performed. Studies published in languages other than English were excluded.

      Incidence/prevalence

      The estimated incidence of adult CVT is 1.32 per 100 000 person-years. Among women aged between 31 and 50 years, the incidence is as high as 2.78 per 100 000 person-years.8 9 In children less than 18 years of age, the estimated incidence is 0.67 per 100 000 children per year, with neonates the most affected age group.10 Risk factors and conditions known to be associated with CVT are listed in …

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