학술논문
Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia.
Document Type
Author
Krzywicka, Katarzyna; Aguiar de Sousa, Diana; Cordonnier, Charlotte; Bode, Felix J; Field, Thalia S; Michalski, Dominik; Pelz, Johann; Skjelland, Mona; Wiedmann, Markus; Zimmermann, Julian; Wittstock, Matthias; Zanotti, Bruno; Ciccone, Alfonso; Bandettini di Poggio, Monica; Borhani-Haghighi, Afshin; Chatterton, Sophie; Aujayeb, Avinash; Devroye, Annemie; Dizonno, Vanessa; Geeraerts, Thomas; Giammello, Fabrizio; Günther, Albrecht; Ichaporia, Nasli R; Kleinig, Timothy; Kristoffersen, Espen S; Lemmens, Robin; De Maistre, Emmanuel; Mirzaasgari, Zahra; Payen, Jean-Francois; Putaala, Jukka; Petruzzellis, Marco; Raposo, Nicolas; Sadeghi-Hokmabadi, Elyar; Schoenenberger, Silvia; Umaiorubahan, Meenakshisundaram; Sylaja, Padmavathy N; van de Munckhof, Anita; Sánchez van Kammen, Mayte; Lindgren, Erik, 1993; Jood, Katarina, 1966; Scutelnic, Adrian; Heldner, Mirjam R; Poli, Sven; Kruip, Marieke J H A; Arauz, Antonio; Conforto, Adriana B; Aaron, Sanjith; Middeldorp, Saskia; Tatlisumak, Turgut; Arnold, Marcel; Coutinho, Jonathan M; Ferro, José M
Source
European journal of neurology. 30(5):1335-1345
Subject
Language
English
ISSN
1468-1331
Abstract
Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is an adverse drug reaction occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. CVST-VITT patients often present with large intracerebral haemorrhages and a high proportion undergoes decompressive surgery. Clinical characteristics, therapeutic management and outcomes of CVST-VITT patients who underwent decompressive surgery are described and predictors of in-hospital mortality in these patients are explored.Data from an ongoing international registry of patients who developed CVST within 28days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 10 May 2022, were used. Definite, probable and possible VITT cases, as defined by Pavord et al. (N Engl J Med 2021; 385: 1680-1689), were included.Decompressive surgery was performed in 34/128 (27%) patients with CVST-VITT. In-hospital mortality was 22/34 (65%) in the surgical and 27/94 (29%) in the non-surgical group (p<0.001). In all surgical cases, the cause of death was brain herniation. The highest mortality rates were found amongst patients with preoperative coma (17/18, 94% vs. 4/14, 29% in the non-comatose; p<0.001) and bilaterally absent pupillary reflexes (7/7, 100% vs. 6/9, 67% with unilaterally reactive pupil, and 4/11, 36% with bilaterally reactive pupils; p=0.023). Postoperative imaging revealed worsening of index haemorrhagic lesion in 19 (70%) patients and new haemorrhagic lesions in 16 (59%) patients. At a median follow-up of 6months, 8/10 of surgical CVST-VITT who survived admission were functionally independent.Almost two-thirds of surgical CVST-VITT patients died during hospital admission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.