Outcomes After Decompressive Surgery for Severe Cerebral Venous Sinus Thrombosis Associated or Not Associated with Vaccine-Induced Immune Thrombosis with Thrombocytopenia: A Multicenter Cohort Study.

Abstract

BACKGROUND:

Clinical observations indicated that vaccine-induced immune thrombosis with thrombocytopenia (VITT)-associated cerebral venous sinus thrombosis (CVST) often has a space-occupying effect and thus necessitates decompressive surgery (DS). While comparing with non-VITT CVST, this study explored whether VITT-associated CVST exhibits a more fulminant clinical course, different perioperative and intensive care unit management, and worse long-term outcome.

METHODS:

This multicenter, retrospective cohort study collected patient data from 12 tertiary centers to address priorly formulated hypotheses concerning the clinical course, the perioperative management with related complications, extracerebral complications, and the functional outcome (modified Rankin Scale) in patients with VITT-associated and non-VITT CVST, both with DS.

RESULTS:

Both groups, each with 16 patients, were balanced regarding demographics, kind of clinical symptoms, and radiological findings at hospital admission. Severity of neurological symptoms, assessed with the National Institute of Health Stroke Scale, was similar between groups at admission and before surgery, whereas more patients with VITT-associated CVST showed a relevant midline shift (≥ 4 mm) before surgery (100% vs. 68.8%, p = 0.043). Patients with VITT-associated CVST tended to undergo DS early, i.e., ≤ 24 h after hospital admission (p = 0.077). Patients with VITT-associated CVST more frequently received platelet transfusion, tranexamic acid, and fibrinogen perioperatively. The postoperative management was comparable, and complications were evenly distributed. More patients with VITT-associated CVST achieved a favorable outcome (modified Rankin Scale ≤ 3) at 3 months (p = 0.043).

CONCLUSIONS:

Although the prediction of individual courses remains challenging, DS should be considered early in VITT-associated CVST because an overall favorable outcome appears achievable in these patients.

• Authors: Johann Otto Pelz, Martin Kenda, Angelika Alonso, Nima Etminan, Matthias Wittstock, Wolf-Dirk Niesen, Johann Lambeck, Erdem Güresir, Johannes Wach, Tim Lampmannn, Rainer Dziewas, Markus Wiedmann, Hauke Schneider, Antonios Bayas, Monika Christ, Annerose Mengel, Sven Poli, Dirk Brämer, Dirk Lindner, Christian Pfrepper, Christian Roth, Farid Salih, Albrecht Günther, Dominik Michalski, IGNITE Study Group
• Journal: Neurocritical care (Neurocrit Care) Vol. 40 Issue 2 Pg. 621-632 (Apr 2024) ISSN: 1556-0961 [Electronic] United States
• PMID: 37498459 (Publication Type: Multicenter Study, Journal Article)
• Copyright: © 2023. The Author(s).

Topics

• Humans
• Retrospective Studies
• Sinus Thrombosis, Intracranial (etiology, surgery)
• Thrombosis (complications)
• Thrombocytopenia (chemically induced)
• Disease Progression