Abstract DP375: Exploring Clinical Drivers of Endovascular Intervention in Pediatric Cerebral Venous Thrombosis

Introduction: Cerebral venous sinus thrombosis (CVST) in pediatric populations presents a diagnostic and therapeutic challenge. While anticoagulation remains the mainstay of treatment, mechanical thrombectomy (MT) is increasingly considered in severe or refractory cases. This study aims to identify clinical, radiographic, and outcome-related factors associated with the decision to pursue MT in children with CVST. Methods: A retrospective cohort analysis was conducted on pediatric patients diagnosed with CVST. Patients were stratified on whether they underwent MT. Demographic data, premorbid conditions, presenting symptoms, imaging findings, treatments, and outcomes were compared between groups using appropriate statistical tests. Results: A total of 37 pediatric CVST cases were analyzed, of which 9 (24.3%) underwent MT. Patients in the MT group were significantly older (mean age 11.78 vs. 6.86 years, p = 0.03) and more likely to have a hypercoagulable state (55.6% vs. 0%, p = 0.0002), autoimmune disease (33.3% vs. 0%, p = 0.01), and focal neurological deficits on presentation (66.7% vs. 14.3%, p = 0.0081). Imaging revealed higher involvement of the deep venous system in the MT group (44.4% vs. 10.7%, p = 0.07) (Table 1). All 9 patients achieved partial recanalization. There were no catheter-related complications or new intracerebral hemorrhages. One patient experienced worsening ICH and one had seizures. Hospital length of stay was not significantly different between groups. No patients in the MT group developed epilepsy or worsened developmental delay. In the MT group ,7 of the thrombectomies were performed with the AngioJet™ device, 1 with the 3MAX™ thromboaspiration catheter alongside intracavernous sinus thrombolysis, and 1 with the pRESET™ stentretriever. In the MT group 6 of 9 (66.7%) patients had thrombi in more than 3 venous locations vs 7 of 28 (25.0%) in the medical management group (p = 0.02). Conclusion: MT in pediatric CVST is more likely to be pursued in older children with more widespread venous system involvement, underlying hypercoagulable states, autoimmune conditions, and focal neurological deficits. Despite the severity of presentation, MT was associated with favorable safety outcomes and may be considered in select cases.