Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia

Katarzyna Krzywicka, Diana Aguiar de Sousa, Charlotte J. Cordonnier, Felix S. Bode, Thalia Field, Dominik Michalski, Johann Pelz, Mona Skjelland, Markus Wiedmann, Julian Zimmermann, Matthias Wittstock, Bruno Zanotti, Alfonso Ciccone, Monica Bandettini di Poggio, Afshin Borhani-Haghighi, Sophie Chatterton, Avinash Aujayeb, Annemie Devroye, Vanessa Dizonno, Thomas GeeraertsFabrizio Giammello, Albrecht R. Guenther, Nasli Ichaporia, Timothy S. Kleinig, Espen Kristoffersen, Robin Lemmens, Emmanuel De Maistre, Zahra Mirzaasgari, Jean-Francois Payen, Jukka Putaala, Marco Petruzzellis, Nicolas Raposo, Elyar Sadeghi-Hokmabadi, Silvia Schoenenberger, Meenakshisundaram Umaiorubahan, Padmavathy N. Sylaja, Anita van de Munckhof, Mayte Sanchez van Kammen, Erik Lindgren, Katarina Jood, Adrian R. Scutelnic, Mirjam Heldner, Sven Poli, Marieke J. H. A. Kruip, Antonio B. Arauz, Adriana Conforto, Sanjith Aaron, Saskia Middeldorp, Turgut Tatlisumak, Marcel M. Arnold, Jonathan Coutinho, Jose M. Ferro

Research output: Contribution to journalArticleScientificpeer-review


Background and purpose: Cerebral venous sinus thrombosis due to vaccine-induced im-mune 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.Methods: Data from an ongoing international registry of patients who developed CVST within 28 days 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.
Results: 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 re-flexes (7/7, 100% vs. 6/9, 67% with unilaterally reactive pupil, and 4/11, 36% with bi-laterally reactive pupils; p= 0.023). Postoperative imaging revealed worsening of index haemorrhagic lesion in 19 (70%) patients and new haemorrhagic lesions in 16 (59%) pa-tients. At a median follow-up of 6 months, 8/10 of surgical CVST-VITT who survived ad-mission were functionally independent.Conclusions: Almost two-thirds of surgical CVST-VITT patients died during hospital ad-mission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.
Original languageEnglish
JournalEuropean Journal of Neurology
Issue number5
Pages (from-to)1335-1345
Number of pages11
Publication statusPublished - May 2023
MoE publication typeA1 Journal article-refereed

Fields of Science

  • COVID-19 vaccinations
  • Brain death
  • Cerebral venous thrombosis
  • Coma
  • Surgery
  • 3112 Neurosciences
  • 3124 Neurology and psychiatry

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