Effect of recanalization on clinical outcomes in patients with cerebral venous thrombosis - An ambispective study.

Purpose: Achieving complete recanalization has possible but unproven benefits in cerebral venous/sinus thrombosis (CVST). We reported a cohort of patients with CVST and assessed the factors associated with recanalization and its effect on outcomes.

Methods: We included 123 patients with CVST in this single-center, ambispective, observational study from October 2018 to November 2019. We noted their demographic, clinical, and radiological features, modified Rankin scale (mRS), recanalization status, and the presence of any recurrences while having periodic follow-ups every three months for one year or until complete recanalization, whichever was earlier.

Results: Out of the 123 patients enrolled, we completed the etiological evaluation in 122 and assessed the outcome at discharge in 120. One (0.8%) patient went against medical advice, 2 (1.6%) died in the hospital, and 8 (6.5%) were lost to follow-up at various time points. The majority of the patients were males (75 [60.98%]). Thrombophilia (71 [58.2%]) and hematological conditions (51[41.8%]) were the predominant risk factors for CVST. The majority (107 [95.5%] at three months) of the patients had an mRS of 0-1. Eighty-one (67.5%) and 26 (21.7%) patients attained complete and partial recanalization at their last follow-up, respectively. Involvement of transverse and sigmoid sinus was an independent predictor of poor recanalization (Odds Ratio [OR] {Confidence Intervals [CI]} - 0.2 (0.04-0.7); p = 0.01). Moreover, failure to achieve at least partial recanalization (OR [CI] - 94 [6.8-1296]; p = 0.01) and undergoing a decompression craniectomy (OR [CI] - 26.4 [1.2-582]) were the only factors that independently predicted poor functional outcomes in our cohort.

Conclusion: Most of the patients with CVST had favorable outcomes. Recanalization was a strong predictor of good functional outcomes. Therefore, recanalization status should be considered while deciding when to stop the anticoagulation. However, we found no differences in the outcomes between those who achieved partial and complete recanalization.