Background and Purpose- The hypothesis that venous recanalization prevents progression of venous infarction is not established in patients with cerebral venous thrombosis (CVT). Evidence is also scarce on the association between residual symptoms, particularly headache, and the recanalization grade. We aimed to assess, in patients with CVT treated with standard anticoagulation, (1) the rate of early venous recanalization, (2) whether lack of early recanalization was predictor of parenchymal brain lesion progression, and (3) the prevalence and features of persistent headache according to the recanalization grade achieved. Methods- PRIORITy-CVT (Pathophysiology of Venous Infarction - Prediction of Infarction and Recanalization in CVT) was a multicenter, prospective, cohort study including patients with newly diagnosed CVT. Standardized magnetic resonance imaging was performed at inclusion (≤24 hours of therapeutic anticoagulation), days 8 and 90. Potential imaging predictors of recanalization were predefined and analyzed at each anatomical segment. Primary outcomes were rate of early recanalization and brain lesion progression at day 8. Secondary outcomes were headache (days 8 and 90) and functional outcome (modified Rankin Scale at days 8 and 90). Results- Sixty eight patients with CVT were included, of whom 30 (44%) had parenchymal lesions. At the early follow-up (n=63; 8±2 days), 68% (n=43) of patients had partial recanalization and 6% (n=4) full recanalization. Early recanalization was associated both with early regression (P=0.03) and lower risk of enlargement of nonhemorrhagic lesions (P=0.02). Lesions showing diffusion restriction (n=12) were fully reversible in 66% of cases, particularly in patients showing early venous recanalization. Evidence of new or enlarged hemorrhagic lesions, headache at days 8 and 90, and unfavorable functional outcome at days 8 and 90 were not significantly different in patients achieving recanalization. Conclusions- Venous recanalization started within the first 8 days of therapeutic anticoagulation in most patients with CVT and was associated with early regression of nonhemorrhagic lesions, including venous infarction. There was an association between persistent venous occlusion at day 8 and enlargement of nonhemorrhagic lesions.

中文翻译：

---

抗凝治疗脑静脉血栓形成患者的早期再通。

背景与目的-脑静脉血栓形成（CVT）患者尚无静脉再通阻止静脉梗塞进展的假说。残留症状（尤其是头痛）与再通等级之间的关联也缺乏证据。我们旨在评估接受标准抗凝治疗的CVT患者（1）早期静脉再通的发生率，（2）缺乏早期再通是否是实质性脑部病变进展的预测因素，以及（3）持续性的患病率和特征根据重新通气等级达到头痛。方法-PRIORITy-CVT（静脉梗死的病理生理学-CVT中梗塞和再通的预测）是一项多中心，前瞻性队列研究，包括新诊断为CVT的患者。在第8天和第90天，在纳入（≤24小时治疗性抗凝）时进行了标准化磁共振成像。预先确定了可能的再通血管成像预测指标，并在每个解剖部分进行了分析。主要结局为第8天的早期再通率和脑病变进展，次要结局为头痛（第8​​和90天）和功能结局（改良的Rankin Scale第8和90天）。结果-包括68例CVT患者，其中30例（44％）有实质性病变。在早期随访（n = 63； 8±2天）时，有68％（n = 43）的患者进行了部分再通和6％（n = 4）的完全再通。早期再通与早期消退相关（P = 0.03）和非出血性病变扩大的风险较低（P = 0.02）。表现为扩散受限（n = 12）的病变在66％的病例中是完全可逆的，尤其是表现出早期静脉再通的患者。在实现再通的患者中，新的或扩大的出血性病变，在第8和90天出现头痛以及在第8和90天出现不利的功能结局的证据无显着差异。结论-大多数CVT患者在抗凝治疗的前8天内开始进行静脉再通，并与非出血性病变（包括静脉梗死）的早期消退相关。第8天持续静脉阻塞与非出血性病变扩大之间存在关联。在实现再通的患者中，第8天和第90天的不良功能预后和无明显差异。结论-大多数CVT患者在抗凝治疗的前8天内开始进行静脉再通，并与非出血性病变（包括静脉梗死）的早期消退相关。第8天持续静脉阻塞与非出血性病变扩大之间存在关联。再次通气的患者在第8天和第90天的功能预后和不良转归无显着差异。结论-大多数CVT患者在抗凝治疗的前8天内开始进行静脉再通，并与非出血性病变（包括静脉梗死）的早期消退相关。第8天持续静脉阻塞与非出血性病变扩大之间存在关联。