Abstract: Cerebral venous sinus thrombosis(CVST) is rare and accounts for less than 1% of strokes. The mainstay treatment for CVST is systemic anticoagulation with heparin, but 9%-13% of patients have a poor outcome. In patients who show signs of rapid deterioration, endovascular treatment(ET) is technically feasible and has shown benefit with good recanalization rates in different case series and prospective cohorts. However, it remains unknown whether it improves the clinical outcome of the ET subgroup compared with anticoagulation alone. Therefore, whether acute CVST requires endovascular therapy remains controversial.