Outcomes of Endovascular Thrombectomy in Patients with Cerebral Venous Thrombosis: A Cohort Study of 36,005 Patients

Introduction/Purpose: Cerebral venous thrombosis (CVT) is traditionally managed with anticoagulation. However, for patients who fail anticoagulation or with severe symptoms, endovascular thrombectomy (EVT) has emerged as a treatment option. Objective: This study evaluates outcomes, complications, and comorbidities associated with EVT in patients with CVT. Methods: The 2015-2019 National Inpatient Sample (NIS) was queried for patients admitted to hospitals with ICD-10 diagnosis codes for CVT and procedure codes for EVT. Demographics, comorbidities, complications, and discharge dispositions were compared between patients undergoing EVT and medical management. Multivariate logistic regression determined independent predictors of outcomes, controlling for age, gender, cerebral edema/herniation, hemorrhage, mechanical ventilation, Elixhauser Comorbidity Index, and National Institute of Health Stroke Scale (NIHSS) severity. Odds ratios (OR) were calculated for each complication/outcome. All statistical analyses were performed using Statistical Product and Service Solutions (SPSS) Statistical Software Version 29. Results: A total of 36,005 patients with CVT were identified. Of those, 325 (0.9%) underwent EVT. Patients who underwent EVT were older (49.28±19.08 years vs 43.62±23.29 years, p < 0.001), more likely to be female (61.5% vs. 54.8%, p = 0.016), and had higher rates of diabetes mellitus (18.5% vs. 13.5%, p = 0.012), hypertension (47.7% vs. 31.3%, p < 0.001), and obesity (13.8% vs. 8.1%, p < 0.001). They also had higher NIHSS scores (13.15 vs. 6.17, p < 0.001). EVT was associated with higher in-hospital mortality (15.4% vs. 4.6%, OR 1.627, p = 0.007) and lower routine discharge (29.2% vs. 57%, OR 0.599, p < 0.001). Conclusions: EVT patients had more severe conditions and higher mortality, potentially reflecting baseline severity rather than risks of EVT itself. Careful patient selection is crucial to improving outcomes in this population. Further studies are needed to refine patient selection criteria for EVT in CVT.