Endovascular intervention for refractory pediatric cerebral venous sinus thrombosis

Abstract Object Cerebral venous sinus thrombosis (CVST) is a rare but potentially morbid disease in the pediatric population, and the optimal treatment is not fully understood. Endovascular intervention for this condition has been rarely reported. Methods The Stroke Thrombectomy and Aneurysm Registry (STAR) was queried for patient Results A total of seven patients across five pediatric centers ranging from 7 to 16 years of age were identified with a mean follow up of 28 months. All had underlying conditions predisposing to CVST. Endovascular intervention was undertaken due to neurological deterioration despite systemic anticoagulation; venous infarct was evident pre-operatively in 6 of 7 patients. Mechanical venous thrombectomy was attempted in all individuals, and intrasinus thrombolytic therapy was also performed in three cases. Six patients had favorable outcome with mRS 0 or 1 at 90-days post-procedure; one remained neurologically devastated. Conclusions Endovascular treatment by an experienced interventionalist may be safe and effective in severe cases of CVST in children failing frontline therapy. Those with radiographic or clinical progression despite anticoagulation may be considered for endovascular intervention in a timely manner.