Abstract
Reports of a rare form of cerebral venous sinus thrombosis with profound thrombocytopenia have emerged following introduction of the adenovirus-vectored coronavirus disease 2019 (COVID-19) vaccines. Between March and June 2021, seven cases of refractory vaccine-induced immune thrombotic thrombocytopenia were referred to our institution for mechanical thrombectomy. The condition of 1 patient deteriorated during interhospital transfer, and the remaining 6 underwent successful recanalization. No procedure-related adverse events were reported. At the time of this writing, 3 patients have been discharged with a good functional outcome (mRS 0-1), one required rehabilitation for mild dysarthria and vocal cord palsy (mRS 3), and 2 have died due to severe mass effect. Our anecdotal experience suggests that endovascular therapy may be safe and effective in reducing thrombus burden in selected cases of postvaccination cerebral venous sinus thrombosis.
Highlights
MethodsSeven confirmed cases of Vaccine-induced immune thrombotic thrombocytopenia (VITT) presenting with refractory cerebral venous sinus thrombosis (CVST) were referred to our institution for consideration of endovascular treatment between March 16 and June 10, 2021
There is currently insufficient data to assess the efficacy of endovascular treatment in vaccine-induced cerebral venous sinus thrombosis (CVST) due to the rarity of the condition
Mechanical thrombectomy is effective in achieving a rapid reduction in clot burden while awaiting immune-modulation therapy to neutralize platelet-activating antibodies
Summary
Seven confirmed cases of VITT presenting with refractory CVST were referred to our institution for consideration of endovascular treatment between March 16 and June 10, 2021. Symptom onset ranged between 10 and 14 days after receiving at least 1 dose of the AstraZeneca vaccine. Systemic anticoagulation and immune-modulation therapy had been initiated before patients were accepted for intervention. Of the 6 patients with intracranial bleeds, 5 presented with reduced Glasgow Coma Score and required intubation.
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