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Endovascular treatment for cerebral venous thrombosis: current status, challenges, and opportunities
  1. Mayank Goyal1,
  2. Joachim Fladt2,3,
  3. J M Coutinho4,
  4. Rosalie McDonough3,5,
  5. Johanna Ospel1,3,6
  1. 1Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
  2. 2Neurology, University Hospital Basel, Basel, Switzerland
  3. 3Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
  4. 4Amsterdam University Medical Center, Amsterdam, The Netherlands
  5. 5Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
  6. 6Radiology, University Hospital Basel, Basel, Switzerland
  1. Correspondence to Dr Mayank Goyal, Diagnostic Imaging, University of Calgary 2500 University Drive, NW Calgary, Alberta T2N 1NA, Canada; mgoyal2412{at}gmail.com

Abstract

Cerebral venous thrombosis (CVT) mostly affects young people. So far, endovascular treatment (EVT) has not been shown to be beneficial in CVT, partially because venous EVT tools are not yet fully optimized, and therefore EVT is only used as a rescue treatment in rare cases. Identifying a subgroup of CVT patients that could benefit from EVT is challenging, given the milder course of disease compared with acute ischemic stroke, the paucity of data on prognostic factors (both in the clinical and imaging domain), and the lack of consensus on what constitutes 'technical success' in CVT EVT. In this review, we discuss the major obstacles that are encountered when trying to identify CVT patients that may benefit from EVT, and propose a roadmap that could help to overcome these challenges in the near future.

  • vein
  • thrombectomy
  • thrombolysis
  • stroke
  • device

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Footnotes

  • Twitter @joachimfladt

  • Contributors JO, MG, RM and JF: conceptualization, drafting, and critical revision of the manuscript. All authors: critical revision of the manuscript.

  • 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 MG is a consultant for Medtronic, Stryker, Microvention, GE Healthcare, and Mentice. JO is a consultant for NICOLab.

  • Provenance and peer review Commissioned; internally 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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