Endovascular treatment of cerebral sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia.

Introduction: There is little data on the role of endovascular treatment (EVT) of cerebral venous sinus thrombosis (CVST) due to vaccine-induced immune thrombotic thrombocytopenia (VITT). Here, we describe clinical characteristics and outcomes of CVST-VITT patients who were treated with EVT.
Patients and Methods: We report data from an international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 6 March 2023. VITT was defined according to the Pavord criteria.
Results: EVT was performed in 18/136 (13%) patients with CVST-VITT (92% aspiration and/or stent retrieval, 8% local thrombolysis). Most common indications were extensive thrombosis and clinical or radiological deterioration. Compared to non-EVT patients, those receiving EVT had a higher median thrombus load (4.5 vs 3). Following EVT, local blood flow was improved in 83% (10/12, 95% confidence interval [CI] 54-96). One (6%) asymptomatic sinus perforation occurred. Eight (44%) patients treated with EVT also underwent decompressive surgery. Mortality was 50% (9/18, 95% CI 29-71) and 88% (8/9, 95% CI 25-66) of surviving EVT patients achieved functional independence with a modified Rankin Scale score of 0-2 at follow-up. In multivariable analysis, EVT was not associated with increased mortality (adjusted odds ratio, 0.66, 95% CI 0.16-2.58).
Discussion and Conclusion: We describe the largest cohort of CVST-VITT patients receiving EVT. Half of the patients receiving EVT died during hospital admission, but most survivors achieved functional independence.
Competing Interests: Declaration of conflicting interestThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AA serves as an advisory board member for Bayer and Bristol Myers Squibb and consulting fees for Boheringer Ingelheim. ABC received consulting fees from Boehringer Ingelheim. SM reports grants from Bayer, Pfizer, Boehringer Ingelheim and Daiichi Sankyo paid to her institution, and personal fees from Bayer, BMS/Pfizer, Boehringer Ingelheim, Abbvie, Portola/Alexion and Daiichi Sankyo paid to her institution. AG received speaker’s honoraria from Boehringer Ingelheim, Daichii Sankyo, Pfizer, Occlutech, Merz, and Ipsen. CGE received funding to attend a conference from Boehringer Ingelheim and Bayer and speaker honoraria from the AAN. AS has received a grant from Swiss Heart Foundation. CC received speaker honoraria from Boehringer Ingelheim, personal fees for advisory board participation from AstraZeneca and Biogen, and personal fees from Biogen and Bristol Myers Squibb. CGE received travel funding from Boehringer Ingelheim and Bayer and speaker honoraria from the AAN. DAS reports travel support from Boehringer Ingelheim, DSMB participation for the SECRET trial, advisory board participation for AstraZeneca and membership on the ESO Executive Committee. EL received grants from the Swedish State, Swedish Neurologic Society, Elsa and Gustav Lindh’s Foundation, P-O Ahl’s Foundation and Rune and Ulla Amlöv’s Foundation. FD is a consultant/proctor for Cerenovus/Johnson&Johnson, Balt, Cerus Endovascular and Phenox and received speaker’s honoraria from Acandis, Stryker, Cerenovus/Johnson&Johnson, Asahi and research support from Cerenovus/Johnson&Johnson. JMC received grants paid to his institution from Boehringer Ingelheim and Bayer for DSMB participation by Bayer. JMF reports fees and DSMB or Advisory Board participation for Boehringer Ingelheim and consulting fees from Bayer. JPa received personal fees from Boehringer Ingelheim, Bayer, Herantis Pharma and Abbott and stock ownership in Vital Signum. MA reports compensation from Amgen, AstraZeneca, Bayer, Bristol Myers Squibb, Covidien, Daiichi Sankyo, Novartis, Sanofi, Pfizer, Medtronic and research grants from the Swiss National Science Foundation and the Swiss Heart Foundation. MP received personal fees for advisory board participation from Alexion. MRH reports grants from the Swiss Heart Foundation, the Bangerter Foundation, Swiss National Science Foundation, and SITEM Research Funds, and Advisory Board participation for Amgen. NR received research grants from Fulbright, Harvard University and Philippe Foundation. RL reports fees paid to his institution by Boehringer Ingelheim, Genentech, Ischemaview, Medtronic, and Medpass. SN has received consulting fees from Brainomix and lecture fees from Boehringer Ingelheim and BMS-Pfizer. SP received research support from BMS/Pfizer, Boehringer-Ingelheim, Daiichi Sankyo, European Union, German Federal Joint Committee Innovation Fund, and German Federal Ministry of Education and Research, Helena Laboratories and Werfen and speakers’ honoraria/consulting fees from Alexion, AstraZeneca, Bayer, Boehringer-Ingelheim, BMS/Pfizer, Daiichi Sankyo, Portola, and Werfen. TK received personal fees from Boehringer Ingelheim. TSF received study medication from Bayer Canada and personal fees from HLS Therapeutics. TT has received personal fees from Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Inventiva, and Portola Pharma. All other authors declare that there is no conflict of interest.