• James E Siegler, Liqi Shu, Shadi Yaghi, Salehi OmranSetarehS0000-0002-3184-5327Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA., Marwa Elnazeir, Ekaterina Bakradze, Marios Psychogios, Gian Marco De Marchis, Siyuan Yu, Piers Klein, Mohamad Abdalkader, Thanh N Nguyen, and ACTION-CVT Investigators.
• Department of Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA.
• Neurosurgery. 2022 Nov 1; 91 (5): 749755749-755.

BackgroundEndovascular treatment (EVT) for cerebral vein thrombosis (CVT) has not been proven to be more effective than anticoagulation based on recent results of the Thrombolysis or Anticoagulation for Cerebral Venous Thrombosis (TO-ACT) randomized clinical trial.ObjectiveTo compare outcomes of EVT vs medical management in CVT.MethodsWe compared EVT vs medical management in a retrospective multinational cohort of consecutive patients with CVT across 4 countries (USA, Italy, Switzerland, and New Zealand) and 27 sites (2015-2020), using propensity score matching (PSM) and inverse probability treatment weighting (IPTW), and meta-analyzed these results with the TO-ACT trial. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] 0-1) at 90 days.ResultsOf the 987 patients, the mean age was 45.7 ± 16.9 years and 79 (8%) underwent EVT. With PSM (n = 124), there were no major differences in clinical or imaging features between groups other than a higher proportion of female patients receiving EVT (81% vs 65%, P = .04). There was no difference in the primary outcome with PSM (odds ratio [OR] 1.48, 95% CI, 0.55-3.96) or IPTW (OR 1.02, 95% CI, 0.34-3.06). EVT was associated with a higher 90-day shift in modified Rankin Scale (OR 2.00, 95% CI, 1.01-3.98) and mortality with IPTW (OR 4.60, 95% CI, 1.10-19.23) but no other differences in secondary outcomes with PSM or IPTW. A meta-analysis of primary and secondary outcomes from TO-ACT and PSM patients from anticoagulation in the treatment of cerebral venous thrombosis also showed no significant association with EVT in primary or secondary outcomes.ConclusionIn this large observational cohort, there was no evidence of benefit with EVT for CVT. These findings corroborate the results from the TO-ACT trial.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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