Efficacy and safety of endovascular mechanical thrombectomy for cerebral venous sinus thrombosis: meta-analysis

Background Cerebral venous sinus thrombosis (CVST) is an uncommon yet potentially disabling cause of stroke that predominantly affects young adults. Anticoagulation remains the cornerstone of treatment; however, a subset of patients experience clinical deterioration despite adequate anticoagulation. Consequently, endovascular mechanical thrombectomy (EMT) has been introduced for high-risk or refractory cases, though its efficacy and safety remain controversial. Methods PubMed, Embase, the Cochrane Library, and Europe PMC were systematically searched to identify studies comparing EMT with anticoagulation or alternative endovascular treatment in patients with CVST; the database searches covered eligible studies through May 2026. Mortality was designated as the primary outcome; mRS ≤ 2, recurrence, and complications were secondary outcomes. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using random-effects (DerSimonian–Laird) models. Sensitivity, subgroup, and publication-bias analyses were performed. Results Overall, 19 studies were included (18 non-randomized and one randomized). EMT was associated with increased odds of mortality in the primary model (12 studies; OR 1.67; 95% CI 1.09–2.56; p = 0.019; I 2 = 6.7%); however, this association was not robust on leave-one-out analysis, and a sensitivity analysis additionally including a National Inpatient Sample administrative-database study yielded an OR of 1.96 (13 studies; 95% CI 1.20–3.22). EMT had no significant effect on mRS ≤ 2 (14 studies; OR 0.83; 95% CI 0.37–1.85; p = 0.650), recurrence (6 studies; OR 0.80; 95% CI 0.33–1.89; p = 0.605), or complications (10 studies; OR 1.20; 95% CI 0.55–2.64; p = 0.643). Conclusion Since EMT is preferentially applied to the most severely affected patients, the observed association between EMT and mortality may substantially reflect confounding by indication and should not be interpreted as evidence of procedural harm. Randomized trials are needed to define the role of EMT in CVST. Clinical trial registration INPLASY202540001.