Outcomes of Endovascular Treatment in Medically Refractory Cerebral Venous Thrombosis: A Prospective Observational Study

Abstract Background and Objectives: Cerebral venous thrombosis (CVT) accounts for <0.5%–3% of all strokes but is increasingly identified with the availability of advanced imaging. Standard anticoagulation therapy is effective in most cases; however, a subset of patients experience clinical deterioration despite optimal medical management. Endovascular treatment (EVT) has emerged as a potential rescue therapy, though evidence remains limited due to the absence of randomized controlled trials. We aimed to evaluate the efficacy and safety of EVT in severe, medically refractory CVT cases at a tertiary care center in central India. Methods: This prospective study included 36 patients with severe CVT who underwent EVT over 30 months. Procedures included catheter-directed thrombolysis, mechanical thrombectomy, and balloon venoplasty. Clinical features, procedural details, and outcomes were recorded. Post-procedure outcomes were assessed using the modified Rankin Scale (mRS) at 3 months. Results: During the study period, out of the total cases of CVT presented to our center, 22.7% underwent endovascular thrombectomy. Of the 36 patients, 89.3% were male, and the majority were younger than 30 years. Headache was a universal presenting symptom, followed by seizures (75%) and focal neurological deficits (58.3%). All patients underwent balloon venoplasty; 35% received adjunctive thrombolysis, and 21% underwent aspiration thrombectomy. Technical success was achieved in all cases. Median mRS improved significantly from 3.0 at baseline to 1.0 at 3 months ( P < 0.001). No major complications occurred. Right sigmoid sinus thrombosis was significantly associated with complications ( P = 0.041). Conclusions: EVT is a safe and effective rescue option for patients with CVT refractory to standard anticoagulation, leading to substantial neurological recovery. Larger multicenter studies are needed to refine patient selection and standardized treatment protocols.