Local thrombolysis combined with balloon dilation for patients with severe cerebral venous sinus thrombosis

Abstract Purpose Anticoagulation is the first-line therapy for cerebral venous sinus thrombosis (CVT). Endovascular treatment is increasingly applied in patients deteriorating despite anticoagulation with extensive thrombosis or contraindications for anticoagulation. Experience with stent retrievers in CVT is limited. Results We present three cases of severe CVT treated with stent-retrievers, thrombus aspiration and local thrombolysis. In two patients with extensive thrombosis, a partial recanalization was achieved, but only one of them showed significant improvement. Despite failed recanalization, the third patient recovered completely. Conclusions Limited experience with three cases indicates that recanalization may not necessarily result in favourable clinical outcome even in severely affected patients. Therefore, invasive procedures such as local thrombolysis and thrombectomy remain individual therapeutic options when anticoagulation fails and in patients with extensive thrombosis.

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Local Thrombolysis for Severe Cerebral Venous Sinus Thrombosis

American Journal of Roentgenology ◽

10.2214/ajr.12.9008 ◽

2012 ◽

Vol 199 (4) ◽

pp. W531-W531

Author(s):

Jan Stam ◽

Susanna M. Zuurbier ◽

Jonathan M. Coutinho

Keyword(s):

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Venous Sinus Thrombosis ◽

Local Thrombolysis

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Local thrombolysis for patients of severe cerebral venous sinus thrombosis during puerperium

European Journal of Radiology ◽

10.1016/j.ejrad.2012.07.019 ◽

2013 ◽

Vol 82 (1) ◽

pp. 165-168 ◽

Cited By ~ 9

Author(s):

Xin-bin Guo ◽

Zhenqiang Fu ◽

Lai-jun Song ◽

Sheng Guan

Keyword(s):

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Venous Sinus Thrombosis ◽

Local Thrombolysis

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Venous Strokes

Rivista di Neuroradiologia ◽

10.1177/19714009050180s210 ◽

2005 ◽

Vol 18 (2_suppl) ◽

pp. 61-66 ◽

Cited By ~ 6

Author(s):

U.S. Limaye

Keyword(s):

Phase I ◽

Sinus Thrombosis ◽

Clinical Status ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Clinical Group ◽

Clinical Grade ◽

Venous Sinus Thrombosis ◽

Local Thrombolysis ◽

A Prospective Study

Management of Venous strokes with the KEM Protocol. Our experience in management of acute and sub-acute cases of venous strokes with heparin or local thrombolysis with urokinase according to KEM Hospital, INR protocol will be presented. All patients included had angiographically proven cerebral venous sinus thrombosis. Patients were classified according to clinical status scale into mild1–3 and severe clinical grade4–6. The study was divided into three phases. Phase I included 27 patients all treated with systemic heparin. Phase Il included 72 patients, 30 were in severe clinical grade and 52 in mild. 26 were thrombolysed with 14 in severe and 12 in mild clinical grade. A prospective study was carried out in 180 patients according to a defined protocol in Phase 111. 133 of these were in mild clinical grade and 47 in the severe. 67 patients were thrombolysed. In the thrombolysed group 27 patients were in mild & 40 in severe clinical grade. 113 patients were treated with systemic heparin. Adjunctive medical therapy was given as required. Following acute management all were anticoagulated for 6 months. Phase I showed 100% mortality in severe clinical group and 23.53% in mild clinical grade. In Phase II mortality in severe clinical group was 75% in non-thrombolysed group and 57.14% in thrombolysed group. There were no deaths in mild clinical grade patients who were thrombolysed. In Phase 111 in Severe clinical grade, mortality in thrombolysed group was 35% and non-thrombolysed group was 100%. In mild clinical group there was 100% recovery in thrombolysed group and 94.4% in non-thrombolysed group. There was complete clinical recovery in 84.4% of patients in Phase 111. 2 patients had intracranial haemorrhage on Urokinase therapy. The line of treatment of venous strokes with heparin or local thrombolysis can be decided according to the KEM protocol. Patients with Cerebral venous sinus thrombosis had better outcome when managed according to our protocol.

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