BackgroundEndovascular treatment (EVT) is gaining popularity for the management of severe forms of cerebral venous thrombosis (CVT), but the evidence supporting its efficacy and safety is limited.MethodsThis multicenter study included patients with CVT admitted to 104 hospitals in 31 provinces/cities in China between January 2018 and June 2022. Propensity score weighting models were used to adjust baseline confounding variables to determine the association of EVT on the primary outcome of good functional status, defined as score 0 - 1 on the modified Rankin Scale after hospital discharge.ResultsOf 3063 patients identified through hospital records searches, 2774 adults [age (42 +/- 15.8) years, female 50.3%] fulfilled eligibility criteria and agreed to be included, of whom 449 (16.2%) received EVT and 2325 (83.8%) received standard care. There was no significant difference between the EVT group and the standard care group in terms of the possibility of good functional recovery [weighted risk ratio = 1.00, 95% confidence interval (CI) 0.96 - 1.03]. Similarly, there was no difference in the likelihood of death at hospital discharge (weighted risk ratio = 1.91, 95% CI 0.91 - 3.68). In subgroup analysis, the possibility of good functional recovery was lower in patients with intracerebral hemorrhage (weighted risk ratio = 0.88, 95% CI 0.79 - 0.98; P for interaction = 0.01) and seizures (weighted risk ratio = 0.86, 95% CI 0.76 - 0.95; P for interaction = 0.03).ConclusionIn this large nationwide study, EVT was not associated with improved functional outcomes compared to standard care in patients with CVT.