Review Article Introduction Cerebral venous sinus thrombosis (CVST) is an important cause of stroke in young people, and has been traditionally treated with systemic anticoagulation with heparin. Recently, arterial strokes have been treated by vascular intervention, which has shown remarkable clinical effcacy and safety in randomized trials. Endovascular mechanical thrombectomy (EMT) may become the standard of care for venous strokes as well, because logically they lead to the immediate clot removal and enhancement of venous outfow, leading to the reduction in edema and venous hypertension, and features of raised intracranial tension. Currently, there are no randomized trials comparing endovascular interventions with systemic anticoagulation. The main presumed advantage of clot removal or lysis is that it improves recanalization. However, it is well known that clinical improvement and recanalization can be dissociated, and patient can have complete clinical recovery in the absence of any recanalization at all. 1 The effcacy of EMT and the safety is still under investigation because most patients with CSVT recover with systemic anticoagulation only. Also, the risks of occurrence or aggravation of intracranial hemorrhage due to the procedure or catheter-related complications are not well characterized. This review is an attempt to consolidate all the available evidence regarding the use of EMT in the management of CSVT. Search Strategy We searched PubMed using the keywords “cerebral venous thrombosis,” “endovascular intervention,” “thombectomy,” “mechanical thrombectomy,” and “intrasinus fbrinolysis,” and the relevant cross references were studied. No rand- omized trials were found. Only case reports, case series, and metaanalyses of case series without control groups were found. Some of the studies compared intrasinus fbrinolysis with mechanical thrombectomy and intrasinus fbrinolysis. Intrasinus Thrombolysis Intrasinus thrombolysis (IST) may be administered through transfemoral, transjugular, transcarotid, or transcranial routes. There are no randomized trials comparing IST with medical management or EMT. Various agents such as streptokinase, urokinase, and tissue plasminogen activator have been tried with good results. IST with urokinase was reported for the frst time in 1988 in a comatose patient, 1 Department of Neurology, JIPMER, Puducherry, India. Corresponding author: Sunil K. Narayan, Comprehensive Stroke Care Centre, Department of Neurology, JIPMER, Puducherry 605006, India. Email: Sunil.narayan@jipmer.edu.in Endovascular Interventional Management of Cerebral Venous Sinus Thrombosis Sunil K. Narayan 1 and Arunmozhimaran Elavarasi 1 Abstract Cerebral venous sinus thrombosis (CVST) is relatively a rare cause of stroke and can have protean manifestations ranging from headache, seizures, diplopia, focal deficits or coma. It is usually managed with anticoagulation. However, various studies have shown a mortality of 13% to 30% and have elucidated certain risk factors such as poor sensorium at presentation and rapid deterioration in spite of anticoagulation, for poor outcomes. In these situations, it has been postulated that endovas- cular management using thrombolysis or mechanical thrombectomy can give better outcomes. This review tries to address the role of endovascular interventions in CVST. Keywords Cerebral venous sinus thrombosis, mechanical thrombectomy, intrasinus thrombolysis, intrasinus fbrinolysis, endovascular mechanical thrombectomy Journal of Stroke Medicine 1(1) 28-33, 2018 © 2018 Indian Stroke Association Reprints and permissions: in.sagepub.com/journals-permissions-india DOI: 10.1177/2516608518774211 journals.sagepub.com/home/stm