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Commentary
Cerebral venous thrombosis after COVID-19 vaccination: the role for endovascular treatment
  1. Amit Mahajan1,
  2. Joshua A Hirsch2
  1. 1 Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
  2. 2 Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Amit Mahajan, Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA; amit.mahajan{at}yale.edu

https://doi.org/10.1136/neurintsurg-2021-018516

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    Cerebral venous thrombosis (CVT) is a unique cause of stroke. Population-based studies demonstrate an incidence of clinically significant CVT of 1.3–1.5 per 100 000 per year.1 2 This may be an underestimated incidence, as these studies were not based on review of imaging and the often benign nature of this entity may lead to underdiagnoses.

    In the JNIS paper published by Cleaver et al,3 the authors describe their experience with endovascular treatment (EVT) in patients with cerebral venous sinus thrombosis in patients following COVID-19 vaccination.

    CVT-related stroke primarily affects young adult and middle-aged patients.4 5 Although initially blamed for having a 50% mortality based on autopsy series,6 more recent prospective multinational studies (International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT)) have demonstrated a mortality rate of 8% in a cohort of 624 patients.7 A total of 75% of these patients were female and 13% had a poor outcome (death or dependence). The baseline risk factors for poor outcome included age >37 years (HR=2.0), male sex (HR=1.6), coma (HR=2.7), mental status disorder (HR=2.0), hemorrhage on admission computed tomography (CT) scan (HR=1.9), thrombosis of the deep cerebral venous system (HR=2.9), central nervous system infection (HR=3.3), and cancer (HR=2.9). Only 8% of these patients were >65 years of age, and had a poorer prognosis.8 Female predilection was lost in the elderly age group, with both sexes affected almost equally.5 Some 46% of these patients demonstrated infarct on CT/magnetic resonance imaging (MRI) while 39% of these patients demonstrated hemorrhage.

    Traditionally, all major guidelines9 have recommended anticoagulation with heparin – preferentially low molecular weight heparin – as the standard treatment for CVT, regardless of the presence of an intracerebral hemorrhage (ICH). Heparin …

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    Footnotes

    • Twitter @Amit_Yale, @JoshuaAHirsch

    • Contributors Both authors contributed equally to this commentary.

    • 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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