Diana Aguiar de Sousa, MD, PhD, University of Lisbon, Santa Maria Hospital, Lisbon, Portugal, discusses the value of achieving venous recanalization in cerebral venous thrombosis (CVT). While the rationale for early recanalization in CVT is strong, the clinical evidence is not as clear as in arterial stroke. The standard of care management approach for CVT is anticoagulation, but the unresolved risk of severe long-term disability and death necessitates new, well-evidenced treatment options. Prof. Aguiar de Sousa highlights her recent prospective study which utilized MRI at several time points after CVT to assess the association between venous recanalization and favorable outcomes. It was seen that more than three quarters of patients achieved at least partial recanalization within 8 days, whilst receiving standard anticoagulation treatment. Those with persistent occlusion had a much higher risk of new brain lesions by day 8, as well as persistent high levels of MMP9, a marker of blood-brain-barrier disruption. A systematic review considering this data and other recent studies also noted an association between recanalization and stroke recurrence and headache. While the evidence seems to support a correlation between venous recanalization and improved outcomes, more data is needed on how to predict who will achieve recanalization and which patients may benefit from more invasive treatments to promote restoration of blood flow. This interview took place during the European Stroke Organisation Conference (ESOC) in Munich, Germany.

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