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Venous collateral drainage patterns predict clinical worsening in dural venous sinus thrombosis.

Abstract：

BACKGROUND:Dural venous sinus thrombosis (DVST) is an increasingly recognized cause of a wide array of neurological symptoms, with outcomes that range from complete recovery to death. The condition of approximately 23% of patients with DVST will worsen after initial presentation, as a result of restricted venous outflow and venous hypertension, but early identification of this subset is challenging. A venous collateral scale (VCS) that grades alternative drainage routes may improve prediction of clinical deterioration. OBJECTIVE:To examine the ability of the VCS system to accurately identify patients with DVST who will experience clinical worsening, based on their imaging at presentation. METHODS:From our institutional database, we identified patients with DVST on dedicated venous imaging between January 2010 and July 2016. A VCS was created and calculated from venous imaging at presentation by two reviewers blinded to subsequent data. RESULTS:The 27 patients who met the inclusion criteria for this study had a median age of 42 years and 14 (52%) were female. Initial symptoms included headache without hemorrhage in 30% and focal deficit in 30%. Transverse sinus occlusion was present in 70% and superior sagittal sinus occlusion in 41%. VCS was 0 in 11%, 1 in 37%, and 2 in 52%. A lower VCS was significantly associated with clinical worsening both from time of initial symptom onset (77% vs 29%, VCS 0-1 vs 2, p<0.05) and during hospitalization (62% vs 0%, VCS 0-1 vs 2, p<0.01). In multivariate analysis, VCS but no other presenting features was significantly associated with in-hospital worsening (OR=2, p<0.01). CONCLUSIONS:The type and quality of venous collaterals influence outcome in DVST. VCS helps to identify patients whose condition is likely to deteriorate and may need additional aggressive interventions.

journal_name

J Neurointerv Surg

journal_title

Journal of neurointerventional surgery

authors

Sheth SA,Trieu H,Liebeskind DS,Saver JL,Szeder V,Jahan R,Tateshima S,Duckwiler G

doi

10.1136/neurintsurg-2016-012941

subject

Has Abstract

pub_date

2018-02-01 00:00:00

pages

171-175

issue

eissn

1759-8478

issn

1759-8486

pii

neurintsurg-2016-012941

journal_volume

pub_type

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Venous collateral drainage patterns predict clinical worsening in dural venous sinus thrombosis.