• Chengwei Chen, Xu Li, Lifa Huang, Jingru Zhang, Suihong Chen, Hui Ye, Qiang Ye, Tiehui Zhang, Xin Zhang, Zupeng Chen, Chao Yang, and Xiaolong Liang.
• Department of Neurosurgery, Chinese Medicine Hospital of Zhejiang Province, The First Affiliated Hospital of Zhejiang Chinese Medicine University, Zhejiang Chinese Medicine University, Hangzhou, Zhejiang, China. Electronic address: edison99x@163.com.
• World Neurosurg. 2019 May 1; 125: 489-497.e14.

ObjectiveThe first-line treatment of cerebral venous sinus thrombosis (CVST) is systemic anticoagulation. However, patients with severe or a clinically worsening condition might benefit from mechanical thrombectomy (MT) combined with intraoperative thrombolysis (IOT) or MT with continuous thrombolytic infusion (CTI). The present study compared the efficacy and safety of these 2 endovascular therapeutic methods by performing a systematic review of the literature.MethodsThe present systematic review was conducted to identify all cases of CVST treated with MT+IOT or MT+CTI/MT+IOT+CTI reported in PubMed and Ovid. The recanalization rates, outcomes, operation-related complications, sequelae, and postoperative hemorrhage rates were evaluated.ResultsA total of 28 studies, including 82 patients, met the inclusion criteria. Alone, MT+IOT was performed in 42 patients (51%), and MT+CTI/MT+IOT+CTI was performed in 40 patients (49%). Overall, outcomes data were available for 69 patients, of whom 57 (82%) had had a good outcome and 12 (18%) had had a poor outcome or had died. Recanalization data were available for 68 patients. Of these patients, 28 (41%) had had complete recanalization, 40 (59%) had had partial, and no patient had had no recanalization. Operation-related complications occurred in 5 patients (6%), and 3 patients (4%) developed postoperative intracerebral hemorrhage. However, no significant differences were found in the recanalization rate or prognosis between the MT+IOT and MT+CTI/MT+IOT+CTI groups.ConclusionsThe results from our review suggest that MT with local thrombolysis is relatively safe, with no significant differences in efficacy and safety between MT+IOT alone and MT+CTI/MT+IOT+CTI. However, randomized controlled studies are required to provide a definitive answer on its use for CVST.Copyright © 2019 Elsevier Inc. All rights reserved.

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