Abstract WP10: Prolonged Microcatheter-based Local Thrombolytic Infusion as a Salvage Treatment for Failed Endovascular Treatment for Cerebral Venous Thrombosis: A Multicenter Registry

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Mikayel Grigoryan ◽  
Gaurav K Guliani ◽  
Muhammad A Saleem ◽  
Emrah Aytac ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Endovascular Treatment ◽  
Cerebral Venous Thrombosis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Response To Treatment ◽  
Tissue Plasminogen ◽  
Final Response ◽  
Assess Treatment Response ◽  
Multicenter Registry

Background: Transvenous endovascular treatment including combination pharmacological and mechanical modalities is reserved for patients with cerebral venous thrombosis (CVT) not responsive to standard anticoagulation. However, transvenous endovascular treatment may not always be successful in achieving recanalization. Objective: To determine the effectiveness of prolonged microcatheter based local thrombolytic infusion in treatment of patients with CVT who achieved no or suboptimal recanalization with endovascular treatment. Methods: Patients who underwent transvenous endovascular treatment for cerebral venous thrombosis at three hospitals were identified through local registries. The final response to treatment was assessed and prolonged microcatheter based local thrombolytic infusion was instituted in selected patients as second line treatment. Serial angiograms were performed to assess treatment response and determine the duration of infusion. Results: Of the 85 patients admitted with CVT, 13 patients underwent 14 transvenous endovascular treatments. Initial treatment was considered suboptimal in 10/14 procedures due to no recanalization in 6, partial recanalization in 3, and re-occlusion in 1 patient. A prolonged microcatheter-based local recombinant tissue plasminogen activator (rt-PA) infusion was used in 9 of the 10 procedures for a median duration of 16 hours (range 15-22 hours). Follow up angiography demonstrated complete recanalization in 4 procedures and improvement of the partial recanalization in 5 additional procedures. One patient died before the follow up imaging could be acquired. None of the patients developed intracranial hemorrhage associated with local thrombolytic infusion. The microcatheter position had shifted during the infusion in one procedure. Conclusion: Prolonged microcatheter based local thrombolytic infusion appears to effective treatment in patients who have suboptimal response to acute transvenous endovascular treatment without any additional adverse events.

scholarly journals Treatment of Progressive Cerebral Sinuses Thrombosis with Local Thrombolysis

2012 ◽  
Vol 18 (1) ◽  
pp. 89-96 ◽  
Author(s):  
R. Mohammadian ◽  
B. Sohrabi ◽  
R. Mansourizadeh ◽  
F. Mohammadian ◽  
A. Nazempour ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Clinical Symptoms ◽  
Oral Contraceptive Pill ◽  
Anticoagulation Therapy ◽  
Recombinant Tissue Plasminogen Activator ◽  
Visual Field Defects ◽  
Blurred Vision ◽  
Local Thrombolysis

Cerebral venous thrombosis (CVT) is a potentially serious disease, with nonspecific clinical symptoms and an unpredictable outcome. Despite adequate anticoagulation, a patient's clinical condition can rapidly deteriorate. The aim of this study was to evaluate the efficacy of local thrombolysis in these patients. Consecutive patients with progressive cerebral venous thrombosis between October 2008 and January 2011 were enrolled prospectively. Progressive CVT was defined as the persistence of neurologic findings (headache, blurred vision, and visual field defects) despite at least four days (or 48 hours in patients with involvement of more than one sinus) on full anticoagulation therapy with heparin and development of focal neurologic deficits or cortical hemorrhage. We excluded patients with large hematomas and predisposing malignancies like leukemia. All patients underwent local thrombolysis with 30 mg recombinant tissue plasminogen activator (rtPA). Overall, 26 patients were enrolled with a mean age of 35.5 years (range 18 to 56 years). Six patients (23%) were male and twenty patients (77%) were female. The most common presenting feature was headache and the most common neurologic finding was papilledema, which was present in all patients. Eighty-five percent of women had a history of oral contraceptive pill consumption. Successful recanalization was achieved in all patients except one (96.2%). Neurological examinations and follow-up assessments were based on a modified Rankin scale (mRS). Favorable outcome and recovery was defined as a mRS score of 0–1. Follow-up assessments at the third week showed that 25 out of 26 recovered, with 18 having a mRS score of 0 and 7 with a mRS score of 1. There were no procedure-related neurological complications. Our results show that local thrombolysis is a safe and effective treatment modality for patients suffering from progressive CVT.

scholarly journals Threshold-based Identification of Persistent Infarction after Successful Endovascular Treatment: Re-evaluating the “Core”

2020 ◽  
Author(s):  
Raphael Meier ◽  
Paula Lux ◽  
Richard McKinley ◽  
Simon Jung ◽  
Urs Fischer ◽  
...  
Keyword(s):  
White Matter ◽  
Endovascular Treatment ◽  
Recombinant Tissue Plasminogen Activator ◽  
Volumetric Analysis ◽  
Lesion Volume ◽  
Tissue Plasminogen ◽  
Optimal Values ◽  
Magnetic Resonance Imaging Mri ◽  
Improved Accuracy

AbstractObjectivesThe objectives of this study included the volumetric analysis of persistent infarction and lesion reversal in Diffusion-Weighted Imaging (DWI), as well as the assessment of accuracy of ADC thresholds to identify regions of persistent infarction in patients with acute ischemic stroke after successful endovascular treatment (EVT).Materials and MethodsA retrospective analysis of patients with M1 or proximal M2 occlusions, treated between 01/2012 and 07/2017, who underwent successful EVT (≥TICI 2b) and both pre- and post-interventional Magnetic Resonance Imaging (MRI), led to the inclusion of N=90 patients. Administration of recombinant tissue plasminogen activator (rTPA) for intra-venous thrombolysis was performed ahead of intervention in 45 cases (N=45/90, 50%). The majority of patients (N=78/90, 86.7%) were treated with second-generation thrombectomy devices with or without intra-arterial urokinase. DWI at admission and 24-hour follow-up DWI data were co-registered. Acute ischemic changes at baseline DWI, 24-hour DWI lesion, and the affected gray/white matter regions were manually annotated. Persistent infarction was defined as acute ischemic changes on baseline DWI, which were sustained on 24-hour follow-up DWI. Based on the manual annotations, persistent infarction and DWI reversal were quantified in a voxel-wise analysis. Thresholds for the identification of persistent infarction using baseline ADC images were estimated by maximizing Youden’s J statistic (ROC-analysis).ResultsMedian age of the patients was 71.9 years (IQR 60.4–79.7 years), 55.6% were female, and NIHSS at admission was 11 (IQR 6–14). The median DWI lesion volume at baseline was 9.9 mL (IQR 3–23.6 mL) and the median DWI lesion volume around 24 hours was 12.1 mL (IQR 3.6–23.7 mL). Reversal of acute ischemic changes occurred frequently (49.8%, IQR 31.7%–65.4%; percentage of initial DWI lesion volume per subject). Sizeable DWI reversal (i.e. >10 mL and >10%) was observed in 26.7% (N=24/90) of the cases. Relative DWI reversal was significantly higher in white matter (58.6%, IQR 35.3–81.5%) than in gray matter (39.2%, IQR 24.9–56.6%; p<0.001). The volume of persistent infarction and DWI reversal were both significantly correlated with the DWI lesion volume at baseline (R=0.873–0.945, p<0.001), however, no correlations with time to reperfusion were found (relative volumes: R=-/+0.058, p=0.607). ROC analyses of ADC thresholds yielded optimal values which differed significantly for gray and white matter (p=0.003), and were lower than previously reported thresholds while having significantly improved accuracy (p≤0.015). No correlations between the estimated ADC thresholds and different covariates were found (time from imaging to reperfusion, time from baseline to follow-up imaging, volume of acute ischemic changes).ConclusionsDWI reversal occurs frequently in successfully reperfused patients treated with modern EVT. Identification of persistent infarction using ADC thresholds in baseline DWI remains challenging with notable differences for gray and white matter.

Dural Arteriovenous Fistula Formation Secondary to Cerebral Venous Thrombosis: Longitudinal Magnetic Resonance Imaging Assessment Using 4D-Combo-MR-Venography

2021 ◽  
Author(s):  
Florian F. Schuchardt ◽  
Theo Demerath ◽  
Samer Elsheikh ◽  
Thomas Wehrum ◽  
Andreas Harloff ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Venous Thrombosis ◽  
Endovascular Treatment ◽  
Cerebral Venous Thrombosis ◽  
De Novo ◽  
Fistula Formation ◽  
Mr Venography ◽  
Resonance Imaging

Abstract Background and Purpose Dural arteriovenous fistulae (DAVFs) can develop secondary to cerebral venous thrombosis (CVT). The incidence of DAVF has not yet been investigated prospectively. Methods Between July 2012 and January 2018, combined static and dynamic 4D MR venography (4D-combo-MRV) was performed in 24 consecutive patients at diagnosis of CVT and after 6 months. 3 Tesla magnetic resonance imaging with time of flight and contrast-enhanced magnetization-prepared rapid acquisition with gradient echo were performed at baseline to evaluate the extent of thrombosis and affected vessel segments. Baseline and follow-up 4D-combo-MRV were assessed for signs of DAVF. Interrater reliability of DAVF detection and the extent of recanalization were analyzed with kappa statistics. Results DAVFs were detected in 4/30 CVT patients (13.3%, 95% confidence interval [CI] 3.3–26.7). Two of 24 patients (8.3%, 95% CI: 0–20.8) had coincidental DAVF with CVT on admission. At follow-up, de novo formation of DAVF following CVT was seen in 2/24 patients (8.3%, 95% CI: 0–20.8). Both de novo DAVFs were low grade and benign fistulae (Cognard type 1, 2a), which had developed at previously thrombosed segments. Endovascular treatment was required in two high degree lesions (Cognard 2a + b) detected at baseline and in one de novo DAVF (Cognard 1) because of debilitating headache and tinnitus. Thrombus load, vessel recanalization, and frequency of cerebral lesions (hemorrhage, ischemia) were not associated with DAVF occurrence. Conclusion This exploratory study showed that de novo DAVF formation occurs more frequently than previously described. Although de novo DAVFs were benign, 75% of all detected DAVFs required endovascular treatment. Therefore, screening for DAVF by dynamic MRV, such as 4D-combo-MRV, seems worthwhile in CVT patients.

Abstract WP2: Trends of Endovascular Treatment in Cerebral Venous Thrombosis: Estimations From Nationwide Inpatient Sample

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Fazeel M Siddiqui ◽  
Matthew Weber ◽  
Sudeepta Dandapat ◽  
Nazan Aksan ◽  
Steve Scaife ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Endovascular Treatment ◽  
Cerebral Venous Thrombosis ◽  
Nationwide Inpatient Sample

scholarly journals Epidemiology, Endovascular Treatment, and Prognosis of Cerebral Venous Thrombosis: US Center Study of 152 Patients

2017 ◽  
Vol 6 (6) ◽  
Author(s):  
Kristin Salottolo ◽  
Jeffrey Wagner ◽  
Donald F. Frei ◽  
David Loy ◽  
Richard J. Bellon ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Endovascular Treatment ◽  
Cerebral Venous Thrombosis ◽  
Center Study

Thalamic Hemorrhagic Stroke in the Term Newborn: A Specific Neonatal Syndrome With Non-uniform Outcome

2017 ◽  
Vol 32 (8) ◽  
pp. 746-753 ◽  
Author(s):  
Laura Merlini ◽  
Sylviane Hanquinet ◽  
Joel Fluss
Keyword(s):  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Hemorrhagic Stroke ◽  
Late Onset ◽  
Predicting Factors ◽  
Anterior Thalamus ◽  
Cerebral Sinus Venous Thrombosis ◽  
Cerebral Sinus ◽  
Deep Cerebral Venous Thrombosis

Background: Neonatal thalamic hemorrhagic stroke is related to cerebral sinus venous thrombosis and associated with neurological sequelae. Predicting factors are however lacking. Methods: Clinical and radiological findings at onset and on follow-up of 5 neonates with thalamic hemorrhage stroke are described. Results: All neonates presented with abrupt lethargy, ophistotonos, irritability and/or seizures. The thalamic hemorrhagic stroke was most often unilateral (4/5), involving the posterior/entire thalamus in 3 cases and the anterior thalamus in 2. Cerebral venous thrombosis was identified in a single patient. At follow-up, children with unilateral anterior thalamic hemorrhagic stroke demonstrated thalamic atrophy without neurological symptoms, whereas children whose thalamus lesion was extensive exhibit a porencephalic cavity and presented with late-onset epilepsy. Discussion: Although deep cerebral venous thrombosis is probably the cause of neonatal thalamic hemorrhagic stroke, its radiological evidence is challenging. Outcome seems dependent of the size and location of thalamic hemorrhagic stroke. Epilepsy is a frequent morbidity after thalamic hemorrhagic stroke.

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