ABSTRACT NUMBER: ESOC2026A1544 REAL-WORLD CEREBRAL VENOUS SINUS THROMBOSIS IN A COMPREHENSIVE STROKE CENTRE: PRESENTATION, MANAGEMENT AND OUTCOMES

Abstract Background and aims Cerebral venous sinus thrombosis (CVST) presents a significant diagnostic challenge with highly variable clinical outcomes. While anticoagulation remains the standard of care, the role of endovascular therapy (EVT) in severe cases is evolving. We aimed to characterise the clinical profile, contemporary management strategies - specifically the utilization of EVT - and outcomes of CVST in a Comprehensive Stroke Centre. Methods We conducted a retrospective observational study of all CVST cases managed between January 2018 and August 2025 in a comprehensive stroke centre. Demographic data, clinical presentation, radiological burden, and therapeutic interventions were analysed. Results Over the 7-year period, 127 confirmed CVST cases were identified (mean age 43 ±17 years, M:F,45:55). While headache was the most common presentation (45%), a significant proportion presented with altered consciousness (26.7%). Involvement of the transverse/sigmoid sinus occurred in 48.8% of cases. Notably, venous thrombectomy was performed in 16.5% (n=21) of patients. This subgroup had distinct high clinical severity; 47.6% (10/21) of thrombectomy patients required subsequent neurosurgical intervention (decompressive hemicraniectomy or shunting). The overall cohort mortality rate was 13.3% (n=17) with a mortality rate of 33% (7/21) in those receiving EVT. Conclusions We report a large contemporary cohort of CVST characterized by high disease severity, likely reflecting the severity of cases referred to our comprehensive stroke centre. We observed a notably high rate of endovascular and neurosurgical intervention (16.5%) compared to historical data. Despite aggressive multimodal management, mortality remains significant, underscoring the need for refined selection criteria for invasive therapies in fulminant CVST. Conflict of interest All authors: Nothing to disclose