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Vascular neurology
Endovascular treatment for vaccine-induced cerebral venous sinus thrombosis and thrombocytopenia following ChAdOx1 nCoV-19 vaccination: a report of three cases
  1. Jonathan Cleaver1,
  2. Richard Ibitoye1,
  3. Hamish Morrison1,2,
  4. Richard Flood3,
  5. Kate Crewdson4,
  6. Aidan Marsh4,
  7. Kumar Abhinav5,
  8. Rose Bosnell6,
  9. Robert Crossley3,
  10. Alex Mortimer3
  1. 1Neurology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
  2. 2Translational Health Sciences, University of Bristol, Bristol, UK
  3. 3Neuroradiology, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
  4. 4Intensive Care Unit, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
  5. 5Neurosurgery, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
  6. 6Stroke, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
  1. Correspondence to Dr Alex Mortimer; alex.mortimer{at}nbt.nhs.uk

Abstract

Background Vaccine-induced thrombosis and thrombocytopenia (VITT) is a rare complication following ChAdOx1 nCoV-19 vaccination. Cerebral venous sinus thrombosis (CVST) is overrepresented in VITT and is often associated with multifocal venous thromboses, concomitant hemorrhage and poor outcomes. Hitherto, endovascular treatments have not been reviewed in VITT-related CVST.

Methods Patient records from a tertiary neurosciences center were reviewed to identify patients who had endovascular treatment for CVST in VITT.

Results Patient records from 1 January 2021 to 20 July 2021 identified three patients who underwent endovascular treatment for CVST in the context of VITT. All were female and the median age was 52 years. The location of the CVST was highly variable. Two-thirds of the patients had multifocal dural sinus thromboses (sigmoid, transverse, straight and superior sagittal) as well as internal jugular vein thromboses. Intracerebral hemorrhage occurred in all patients; subarachnoid blood was noted in two of them, and intraparenchymal hemorrhage occurred in all. There was one periprocedural parenchymal extravasation which abated on temporary cessation of anticoagulation. Outcome data revealed a 90-day modified Rankin Scale (mRS) score of 2 in all cases.

Conclusions We demonstrate that endovascular treatment for VITT-associated CVST is feasible and can be safe in cases that deteriorate despite medical therapy. Extensive clot burden, concomitant hemorrhage, rapid clinical progression and persistent rises in intracranial pressure should initiate multidisciplinary team discussion for endovascular treatment in appropriate cases.

  • COVID-19
  • thrombectomy
  • vein
  • hemorrhage
  • device

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/neurintsurg-2021-018238

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    Footnotes

    • Contributors A.Mortimer and RB conceptualized the manuscript. JC, RI, HM, RF and A.Mortimer created the first draft. RF and AM provided the images. All authors revised the draft.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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