Background and purpose: Although Anticoagulation remains the mainstay of treatment after cerebral venous thrombosis (CVT), 15% of patients may not respond. Evidence of endovascular treatment (ET) in CVT remains limited to case reports. The Nationwide Inpatient Sample (NIS), the largest all-payer inpatient health care database in the United States, represents a 20% stratified sample of community hospitals and approximately 7 million annual hospital admissions. We aimed to evaluate the trends of ET using NIS.
Methods: We extracted data from the NIS between 2004- 2013. CVT patients were identified through ICD 9-CM codes: 437.6, 325 and 671.5. Mechanical thrombectomy (MT) and/or thrombolysis were searched using ICD 9 (CPT) codes 39.74 for Endovascular removal of obstruction from head and neck vessel(s) and 99.10 for any injection or infusion of thrombolytic agent. We compared categorical variables using chi-squared tests and continuous variables with Student t test or Wilcoxon rank-sum tests as indicated. Trends were assessed using a Cochran-Armitage test.
Results: Of 8,891 cases of CVT (un-weighted count), 8676 (98%) cases received only medical management. When the weights were applied, total CVT cases were 42,889. 215 (2%) patients (un-weighted count) received ET. Weighted estimates for ET was 1058. 50 (23%) patients received MT and thrombolysis (weighted 248), 38 (18%) patients received MT alone (weighted 194) and 127 (59%) patients received thrombolysis alone (weighted 616). There was a significantly increasing trend of utilization of the MT over thrombolysis alone over the years (Figure 1).
Conclusion: There is a significant rise in the number of ET cases for CVT over the years, with a trend favoring towards MT over thrombolysis alone.