Trends in Utilization and Outcomes of Thrombectomy for Cerebral Venous Thrombosis: A National Study

Purpose: Cerebral venous thrombosis (CVT) outcomes range from death to long-term dependency. Endovascular approach could be beneficial in adverse effect reduction because it allows direct recanalization of the blood vessel as well as application of thrombolytic agents at the site of the thrombus, preventing systemic effects. There is a literature sparsity regarding the trends in this treatment. This study analyzes Nationwide Inpatient Sample (NIS) to determine the trends of mechanical thrombectomy (MT), including nonroutine discharge and mortality rate.

Materials and Methods: Healthcare Utilization Program-National Inpatient Sample (HCUP-NIS) was queried between 2005 and 2018 for CVT and MT using ICD-9 and -10 codes. Cochrane-Armitage test was used to assess linear trend of proportion of incidences, nonroutine discharge (including transfer to assisted facilities, home health care, acute care, and death) of MT. Multivariable logistic regression was used to assess odds of undergoing MT among CVT admissions. Elixhauser Comorbidity Index (ECI), risk factor score based on 31 comorbidities in NIS, was calculated and used in multivariable regression. Estimates were nationalized using discharge weights provided by HCUP.

Results: A total of 1331 (1.56%) admissions involved MT of 85,370 CVT cases. The mean age was 42.2 years (SE, 1.06), and the number of female patients was 885 (66.5%) for patients undergoing MT. Additionally, a total of 531 (39.9%) admissions involved the use of thrombolysis among those undergoing MT. Cases of CVT increased from 3843 in 2005 to 9310 in 2018. Use of MT had an upward trend of 0.13% (P < 0.001) per year, ranging from 0% in 2005 to 1.99% (n = 185) in 2018. Trend in proportion of incidence of nonroutine among MT admission remained stationary (trend: 0.70; 95% confidence interval, -1.00 to 2.40; P = 0.417). Female patients had similar odds of undergoing MT compared with male patients (odds ratio [OR], 1.30; P = 0.092). Patients with hematologic disorders had higher odds of undergoing MT (OR, 1.99; P < 0.001). Patients with higher ECI scores had higher odds of undergoing MT (OR, 1.20; P < 0.001).

Conclusions: There was an increased incidence of CVT cases with an increasing trend of MT. Proportions of nonroutine discharge among MT procedures, however, remained stable. Patients with greater risk factors, including hematologic disorders and higher ECI scores, were more likely to undergo MT. Prospective studies are warranted to further evaluate the role MT plays in reducing negative outcomes of CVT.