Comparing outcomes of systemic anticoagulant therapy and vascular interventional therapy in cerebral venous sinus thrombosis with concurrent brain parenchymal injury: Biomarker analysis.

Abstract

Background: Cerebral venous sinus thrombosis (CVST) with concurrent brain parenchymal injury is a severe and complex condition that requires effective treatment strategies and long-term follow-ups. This study aimed to evaluate the prognostic value of serum caspase-cleaved cytokeratin-18 (CCCK-18), neuron-specific enolase (N SE), S-100P, nerve growth factor (N GF), and CRP D-Dimer, and EPO in CVST treatment.

Methods: Ninety patients with CVST combined with parenchymal brain had undergone systemic anticoagulant therapy (SAT group) or vascular interventional therapy (VIT group) at Nanyang Second General Hospital from January 2021 to January 2024 were evaluated in this study with 45 patients in each group. Three months after discharge, mRS, NIHSS, GCS, and patients' quality of life were assessed. Peripheral blood samples were collected to measure CRP D-Dimer, EPO, and CCCK-18 level changes. The levels of serum neuron-specific enolase (NSE), S100P, and nerve growth factor (NGF) were compared before and at 3 and 7 days post-treatment. Follow-up at six months post-discharge included calculations of mortality and recanalisation rates.

Results: At 3 months post-discharge, 11.1% of VIT patients had an mRSS2, compared to 35.6% in the SAT group (P< 0.05). The VIT group also had lower NIHSS scores, higher GCS and SF-36 scores, and lower serum CRP EPO, and CCCK-8 levels (P< 0.05). NSE and S-100P levels were lower in the VIT group at 7 days post-treatment (P< 0.05), while NGF levels were higher at 3 days post-treatment (P< 0.05). Follow-up showed no significant difference in survival rates (88.9% vs 95.6%). Still, the VIT group had a lower proportion of patients with mRS>2 (20.0% vs 42.2%) and a higher complete recanalisation rate (73.3% vs 53.3%) (both P< 0.05).

Conclusions: Combined SAT with neurovascular interventional thrombectomy benefits patients with CVST and concurrent brain parenchymal injury by promoting recovery of neurological deficits and consciousness, achieving vascular recanalisation.