J Stroke.  2023 May;25(2):291-298. 10.5853/jos.2023.00213.

Timing and Predictors of Recanalization After Anticoagulation in Cerebral Venous Thrombosis

• Salehi Omran S
• Shu L
• Chang A
• Parikh NS
• Zubair AS
• Simpkins AN
• Heldner MR
• Hakim A
• Kasab SA
• Nguyen T
• Klein P
• Goldstein ED
• Vedovati MC
• Paciaroni M
• Liebeskind DS
• Yaghi S
• Cutting S

• KMID: 2542480
• DOI: http://doi.org/10.5853/jos.2023.00213

Abstract

Background and Purpose
Vessel recanalization after cerebral venous thrombosis (CVT) is associated with favorable outcomes and lower mortality. Several studies examined the timing and predictors of recanalization after CVT with mixed results. We aimed to investigate predictors and timing of recanalization after CVT.
Methods
We used data from the multicenter, international AntiCoagulaTION in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT) study of consecutive patients with CVT from January 2015 to December 2020. Our analysis included patients that had undergone repeat venous neuroimaging more than 30 days after initiation of anticoagulation treatment. Prespecified variables were included in univariate and multivariable analyses to identify independent predictors of failure to recanalize.
Results
Among the 551 patients (mean age, 44.4±16.2 years, 66.2% women) that met inclusion criteria, 486 (88.2%) had complete or partial, and 65 (11.8%) had no recanalization. The median time to first follow-up imaging study was 110 days (interquartile range, 60–187). In multivariable analysis, older age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03–1.07), male sex (OR, 0.44; 95% CI, 0.24–0.80), and lack of parenchymal changes on baseline imaging (OR, 0.53; 95% CI, 0.29–0.96) were associated with no recanalization. The majority of improvement in recanalization (71.1%) occurred before 3 months from initial diagnosis. A high percentage of complete recanalization (59.0%) took place within the first 3 months after CVT diagnosis.
Conclusion
Older age, male sex, and lack of parenchymal changes were associated with no recanalization after CVT. The majority recanalization occurred early in the disease course suggesting limited further recanalization with anticoagulation beyond 3 months. Large prospective studies are needed to confirm our findings.

Keyword

Stroke; Sinus thrombosis, intracranial; Cerebral veins; Vascular disease

Figure

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  Figure 1. Flow diagram depicting patient inclusion in secondary analysis. ACTION-CVT, AntiCoagulaTION in the Treatment of Cerebral Venous Thrombosis. *Numbers do not sum to group total as some patients were excluded for more than one reason.

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