MENA Regional Endovascular Intervention for Venous Cerebral Venous Sinus Thrombosis

Inclusion Criteria: * Age 18-65 years, inclusive * Radiologically confirmed cerebral venous sinus thrombosis (CVST) by CT venography (CTV), MR venography (MRV), or digital subtraction angiography (DSA), with thrombosis of at least one major dural sinus * Acute or subacute presentation with symptom onset within 21 days of randomization * MRI phase characterization confirming acute or subacute phase * At least one risk factor for poor outcome: symptoms of intracranial hypertension (severe headache, papilledema, visual obscurations), focal neurological deficit, seizures, altered consciousness (GCS 9-14), intracranial hemorrhage from venous congestion, or deep venous system thrombosis * Significant venous outflow obstruction on imaging * Written informed consent from patient or legally authorized representative Exclusion Criteria: * Isolated cortical vein thrombosis without dural sinus involvement * Isolated cavernous sinus thrombosis * Chronic-phase CVST on MRI phase characterization * Pre-morbid modified Rankin Scale (mRS) score greater than 2 * Glasgow Coma Scale (GCS) score less than 9 at randomization * Imminent risk of transtentorial herniation requiring emergent decompressive craniectomy * Massive cerebral edema with midline shift greater than 10 mm requiring surgical intervention * Active systemic bleeding or hemorrhagic diathesis * Severe allergy to iodinated contrast media * CVST secondary to active hematological malignancy or life expectancy less than 12 months * Pregnancy * Participation in another interventional clinical trial within 30 days * Any condition rendering the patient unsuitable for study participation per investigator judgment