Trial updates in CVT: latest data on surgical and endovascular treatment

Diana Aguiar de Sousa, MD, PhD, Lisbon Central University Hospital & University of Lisbon, Lisbon, Portugal, discusses the current state of knowledge regarding surgical and endovascular treatment for cerebral venous thrombosis (CVT). She highlights that while most patients recover well, a significant portion remain dependent or experience persistent cognitive, neurological, and neuropsychological issues. Current treatments in severe cases include decompressive surgery and endovascular treatment, though evidence for the latter is still limited. Observational studies have shown that patients who achieve early venous recanalization, typically within the first week of anticoagulation treatment, often experience a faster recovery of brain lesions and better overall outcomes. Early recanalization is associated with a reduction in markers like MMP-9, which are linked to blood-brain barrier disruption and poor outcomes. This suggests that early venous recanalization may be crucial in preventing further neurological damage and improving recovery. However, the precise criteria for identifying patients who would benefit most from additional interventions aimed at promoting early recanalization are still unclear. Prof. Aguiar de Sousa highlights the need for more detailed studies to refine treatment protocols, particularly in determining which patients might require endovascular treatments to achieve recanalization. Prof. Aguiar de Sousa also discusses the publication of DECOMPRESS2, which represents the first prospective study of decompressive surgery in patients with CVT with impending brain herniation. This interview took place at the 10th European Stroke Organisation Conference (ESOC) 2024 in Basel, Switzerland.
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