Evaluating the efficacy of stent retriever and catheter aspiration combination in refractory cerebral venous sinus Thrombosis: A comprehensive Meta-Analysis

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Citações na Scopus
1
Tipo de produção
article
Data de publicação
2024
DOI
Scopus
Web of Science
PubMed
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Título da Revista
ISSN da Revista
Título do Volume
Editora
ELSEVIER SCI LTD
Autores
BATISTA, Savio
SANCHES, Joao Pedro Bittar
ANDREA, Filipi Fim
SOUSA, Marcelo Porto
OLIVEIRA, Leonardo de Barros
FERREIRA, Marcio Yuri
FILHO, Cesar Augusto Ferreira Alves
BRAGA, Fausto de Oliveira
MACHADO, Elias Antonio Tanus
Citação
JOURNAL OF CLINICAL NEUROSCIENCE, v.120, p.154-162, 2024
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: Cerebral Venous Sinus Thrombosis (CVST) is a rare but potentially life-threatening condition, often associated with specific risk factors. The primary treatment for CVST is anticoagulation, but some cases progress to Refractory CVST (rCVST), requiring endovascular treatment. A combination of stent retriever and catheter aspiration is emerging as a promising technique to enhance treatment effectiveness. We conducted a systematic review and meta-analysis to assess the safety and efficacy of this approach, aiming to improve recanalization success and neurological outcomes while reducing complications in rCVST patients. Methods: A search following PRISMA guidelines was conducted across Pubmed, Embase, Web of Science, and Cochrane databases to identify studies on the use of stent retrievers and catheter aspiration for rCVST. Pooled analysis with 95 % confidence intervals was used to assess the effects. Heterogeneity was evaluated using I2 statistics and a random-effects model was used. Complete recanalization. good clinical outcomes (mRS <= 2), hemorrhagic, neurological, ischemic, and total complications, poor clinical outcomes (mRS > 2), and mortality were assessed. Results: A meta-analysis of five retrospective studies involving 55 patients examined outcomes in CVST. The median mean age was 40 years. Complete recanalization rate: 36 % (95 % CI: 9 % to 62 %, I-2 = 90 %). Good clinical outcomes: 72 % (95 % CI: 50 % to 94 %, I-2 = 76 %). Hemorrhagic complications: 2 % (95 % CI: 0 % to 8 %, I-2 = 15 %). Ischemic complications: 0 % (95 % CI: 0 % to 6 %, I-2 = 0 %). Neurological complications: 7 % (95 % CI: 0 % to 14 %, I-2 = 0 %). Poor clinical outcomes: 26 % (95 % CI: 6 % to 46 %, I-2 = 70 %). Total complications: 6 % (95 % CI: 0 % to 15 %, I-2 = 10 %). Mortality rate: 5 % (95 % CI: 0 % to 13 %, I-2 = 19 %). Conclusion: This systematic review and meta-analysis scrutinized the efficacy of combining Stent Retriever and Catheter Aspiration for rCVST. Findings highlighted varied outcomes, including recanalization rates, complications, and mortality. The dichotomy between good and poor outcomes underscores the necessity for personalized therapeutic decisions. While offering a comprehensive overview, the study emphasizes literature heterogeneity, suggesting a need for more rigorous and standardized research to optimize therapeutic strategies in clinical practice.
Palavras-chave
Cerebral venous sinus thrombosis, Stent retriever, Catheter aspiration, Refractory cerebral venous sinus thrombosis
URI
https://observatorio.fm.usp.br/handle/OPI/59161
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Coleções
Artigos e Materiais de Revistas Científicas - HC/ICHC