Supplementary Material for: Radiographic signs of advanced cerebral venous thrombosis negatively modulate the effectiveness of endovascular treatments

Introduction: Endovascular treatment (EVT) is a therapeutic option for cerebral venous thrombosis (CVT); however, its benefit over conservative medical management has not been proven. Whether current patient selection practices are appropriate for EVT is unclear. Methods: This was a nationwide study of the 2016-2020 National Inpatient Sample database. Adult CVT patients and EVT treatments were identified. Patient demographics, medical comorbidities, CVT risk factors, and CVT manifestations were identified. Presence of radiographic signs of advanced and severe CVT (venous infarction, cerebral edema, and intracranial hemorrhage) were recorded. Primary and secondary outcomes were good discharge outcomes and in-hospital mortality, respectively. Results: 17,130 CVT patients were identified, and 56.7% had good discharge outcomes while 4.6% died during hospitalization. 945 (5.5%) received EVT, and EVT patients were more likely to have cerebral infarction (35.4% vs. 21.8%, p<0.001), edema (35.4% vs. 20.1%, p<0.001), and hemorrhage (37.6% vs. 19.7%, p<0.001). After multivariable adjustments, EVT for patients without infarction, edema, or hemorrhage was moderately associated with higher odds of good outcomes (OR 1.86 [95%CI 0.98 - 3.53], p=0.059) and resulted in zero deaths. However, with increasing burden of radiographic signs of advanced CVT measured by the cumulative presence of infraction, edema, and hemorrhage, EVT was associated with decreasing odds of good outcomes and increasing odds of in-hospital mortality compared to medical management (interaction p=0.046 and 0.029, respectively). Conclusions: EVT may lead to higher rates of favorable hospitalization outcomes in patients who have not yet developed overt parenchymal manifestations of backpressure changes; presence of infarction, edema, and hemorrhage may diminish the short-term effectiveness of EVT.

引言：血管内治疗（Endovascular treatment, EVT）是脑静脉血栓形成（cerebral venous thrombosis, CVT）的可选治疗方案之一，但其相较于保守药物治疗的获益尚未得到证实。当前针对血管内治疗的患者遴选标准是否合理尚不明确。
方法：本研究基于2016-2020年美国国家住院患者样本（National Inpatient Sample）数据库开展全国性分析，纳入成年脑静脉血栓形成患者及接受血管内治疗的病例。收集患者的人口统计学特征、合并疾病、脑静脉血栓形成危险因素及临床表现，记录进展性、重症脑静脉血栓形成的影像学征象（包括静脉性梗死、脑水肿及颅内出血）。主要结局指标为出院良好结局，次要结局指标为住院期间死亡率。
结果：本研究共纳入17130例脑静脉血栓形成患者，其中56.7%获得出院良好结局，4.6%在住院期间死亡。945例（5.5%）患者接受了血管内治疗，接受血管内治疗的患者更易出现脑梗死（35.4% vs. 21.8%，P<0.001）、脑水肿（35.4% vs. 20.1%，P<0.001）及颅内出血（37.6% vs. 19.7%，P<0.001）。经多变量校正后，在未出现梗死、水肿或出血的患者中，血管内治疗与更高的出院良好结局比值比存在中等程度关联（比值比1.86，95%置信区间0.98~3.53，P=0.059），且该亚组患者住院期间无死亡病例。然而，随着静脉性梗死、脑水肿及颅内出血累积出现的进展性脑静脉血栓形成影像学征象负荷增加，与药物治疗相比，血管内治疗与出院良好结局的比值比逐渐降低、住院期间死亡的比值比逐渐升高（二者交互作用P值分别为0.046和0.029）。
结论：在尚未出现由静脉压升高引发的明确脑实质损害表现的患者中，血管内治疗可能带来更高的出院良好结局比例；而静脉性梗死、脑水肿及颅内出血的存在可能削弱血管内治疗的短期疗效。