scholarly journals Safety and efficacy of the use of large bore intermediate suction catheters alone or in combination for the treatment of acute cerebral venous sinus thrombosis: A multicenter experience

2019 ◽  
Vol 26 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Sudeepta Dandapat ◽  
Edgar A Samaniego ◽  
Viktor Szeder ◽  
Fazeel M Siddiqui ◽  
Gary R Duckwiler ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Clinical Status ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Suction Catheter ◽  
Aspiration Thrombectomy ◽  
Venous Sinus Thrombosis ◽  
Procedural Complications ◽  
Systemic Anticoagulation ◽  
New Generation

Background and purpose Systemic anticoagulation is the standard treatment for cerebral venous sinus thrombosis (CVST). Several endovascular techniques have been described as salvage therapy for anticoagulation refractory CVST cases. We aim to evaluate the safety and feasibility of endovascular aspiration thrombectomy using the new generation, large bore suction catheters alone or in combination with stentriever devices for the treatment of CVST. Methods We collected data on 16 consecutive patients with CVST who received endovascular aspiration thrombectomy at three large academic centers. Second generation reperfusion catheters were used as a large bore suction catheter and advanced to the affected sinus using a coaxial technique. Suction was performed using pump suction. At times, a stentriever was used as an anchor to facilitate advancing the suction catheter and to increase thrombectomy capabilities. Results Median decade of age was the 50s and nine patients were women. Fifty percent of the patients had multiple sinuses involved. All patients received systemic anticoagulation prior to endovascular aspiration thrombectomy. The most common reason to pursue endovascular aspiration thrombectomy in CVST patients was deterioration of initial clinical status (10/16). The mean time from admission to endovascular aspiration thrombectomy was 1.5 days (range 0–6 days). Good recanalization was obtained in all patients. There were no major peri-procedural complications. Most patients were discharged to either home or a rehabilitation facility. Conclusion Endovascular aspiration treatment using large bore suction catheters for CVST is a safe and feasible approach for the treatment of anticoagulation refractory CVST. Heterogeneity of the clinical and radiological presentation requires further investigation to optimize patient selection before evaluating the efficacy of this technique in larger prospective studies.

scholarly journals Use of the Penumbra System 054 plus Low Dose Thrombolytic Infusion for Multifocal Venous Sinus Thrombosis

2012 ◽  
Vol 18 (3) ◽  
pp. 314-319 ◽  
Author(s):  
F.M. Siddiqui ◽  
G.L. Pride ◽  
J.D. Lee
Keyword(s):  
Mechanical Thrombectomy ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Internal Diameter ◽  
Aspiration Thrombectomy ◽  
Venous Sinus Thrombosis ◽  
Novel Device ◽  
Thrombectomy Device ◽  
New Generation

Multifocal cerebral venous sinus thrombosis (CVST) has a high mortality rate especially when patients present with stupor or coma. Medical treatment including anticoagulation raises concerns about the associated high risk of intracerebral hemorrhage. Treatment of multifocal CVST with mechanical thrombectomy devices and local tPA infusion have previously been reported. However, these devices may have technical limitations. Success of the new-generation aspiration thrombectomy device like the Penumbra system has been reported in few cases of isolated CVST without the use of chemical thrombolysis. We describe two cases in which mechanical thrombectomy were used in conjunction with intra-sinus tPA infusion. Both cases were complicated and failed initial anticoagulation. Penumbra 054 was used in both cases. The Penumbra 054 is a novel device that has a bigger lumen which provides compatibility with other microcatheters, if additional therapies are required. The larger internal diameter of this catheter also allows for stronger thrombo-aspiration, potentially effecting more rapid sinus recanalization. Both cases showed remarkable clinical recovery without any major complications. This is the first reported simultaneous use of the Penumbra system 054 along with tPA infusion. New devices such as the Penumbra system may offer additional therapeutic options in the treatment of multifocal CVST.

Abstract 3070: Assessment of Manual Aspiration Therapy for the Treatment of Sinus Thrombosis

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Lance Bodily ◽  
Mouhammad Jumaa ◽  
Syed Zaidi ◽  
Tudor Jovin ◽  
Brian Jankowitz
Keyword(s):  
Sinus Thrombosis ◽  
Anticoagulation Therapy ◽  
Stable Condition ◽  
Standard Of Care ◽  
Mass Effect ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Motor Deficits ◽  
Aspiration Thrombectomy ◽  
Venous Sinus Thrombosis

Objective: While hydration and anticoagulation is typically the standard of care for cerebral venous sinus thrombosis, some patients remain refractory to medical management and continue to deteriorate. In these instances a number of more aggressive endovascular techniques have been reported to remove clots and restore blood flow in the venous sinuses. These techniques include direct thrombolysis, angioplasty, and various methods to disrupt and aspirate clot. Here we present the technique of endovascular transvenous manual aspiration thrombectomy (MAT) in five patients. Methods: We reviewed the records of five patients with medically refractory cerebral venous sinus thrombosis who received transvenous MAT. Presentation, technique, and outcome were evaluated. Results: Out of the five cases reviewed presentation included vomiting, dehydration, mental status changes, headaches, and acute motor deficits. On imaging three of the five patients had hemorrhage, edema, and mass effect present before treatment, while two had edema only. All of the patients reviewed were treated with anticoagulation therapy, intravenous heparin or subcutaneous lovenox, for a minimum of 24 hours. However, all of the patients continued to deteriorate despite early and aggressive medical anticoagulation therapy. All of the patients demonstrated rapid and progressive worsening of their neurological exam pre-operatively, including lack of arousal, pathological posturing, and expansion of secondary hemorrhages. This rapid deterioration warranted aggressive intervention, making the patients candidates for endovascular therapy. Direct thrombolysis with tPA was utilized with MAT via a distal access catheter(DAC) in all but one patient in which tPA was not used due to concern for hemorrhage. Aspiration of the superior sagittal sinus, transverse sinuses, straight sinus, and internal jugular were all included in this series. Catheters included the 0.070, 0.057, and 0.044 DAC and the 0.054 Penumbra microcatheter. Revascularization was achieved in all instances. One patient presented and remained neurologically devastated. She died 5 days after treatment. All other patients experienced improvement in their neurological examinations and were eventually discharged from the hospital in stable condition. Conclusions: Endovascular transvenous MAT is a feasible and effective revascularization technique to treat patients with cerebral venous sinus thrombosis.

Manual aspiration thrombectomy for cerebral venous sinus thrombosis

2012 ◽  
Vol 5 (6) ◽  
pp. 534-538 ◽  
Author(s):  
Brian Thomas Jankowitz ◽  
Lance Matukas Bodily ◽  
Mouhammad Jumaa ◽  
Zaidi F Syed ◽  
Tudor G Jovin
Keyword(s):  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Aspiration Thrombectomy ◽  
Venous Sinus Thrombosis

scholarly journals Combined use of stent-retriever and aspiration thrombectomy for cerebral venous sinus thrombosis involving the straight sinus: A case report

2017 ◽  
Vol 23 (6) ◽  
pp. 605-608 ◽  
Author(s):  
Syunsuke Taniguchi ◽  
Kei Harada ◽  
Masahito Kajihara ◽  
Kozo Fukuyama
Keyword(s):  
Sinus Thrombosis ◽  
Anticoagulation Therapy ◽  
Cerebral Venous Sinus Thrombosis ◽  
Stent Retriever ◽  
Venous Sinus ◽  
Aspiration Thrombectomy ◽  
Venous Sinus Thrombosis ◽  
Straight Sinus ◽  
Combined Use ◽  
Level Of Consciousness

Cerebral venous sinus thrombosis (CVST) is generally treated with anticoagulation therapy, however, endovascular therapy is considered for refractory cases. A 42-year-old woman presented with a progressive disturbance in consciousness, and diagnosed CVST in the straight sinus (SS). Recanalization of SS was achieved by emergent thrombectomy using aspiration catheter and stent-retriever system, and her level of consciousness improved immediately. The combined use of them aided the removal of the thrombus located in the SS.

scholarly journals LEFT TRANSVERSE VENOUS SINUS THROMBOSIS ASSOCIATED TO PNEUMOCOCCAL MENINGITIS IN CHILDREN – INTUITIVE VS. COGNITIVE DIAGNOSIS

2017 ◽  
Vol 20 (2) ◽  
pp. 84-87
Author(s):  
Maria Obreja ◽  
◽  
Liliana Vlad ◽  
Radu Miftode ◽  
Alexandr Ceasovschih ◽  
...  
Keyword(s):  
Pneumococcal Meningitis ◽  
Sinus Thrombosis ◽  
Clinical Status ◽  
Cerebral Venous Sinus Thrombosis ◽  
Typical Case ◽  
Venous Sinus ◽  
Decision Making Process ◽  
Venous Sinus Thrombosis ◽  
Meningitis In Children ◽  
Anticoagulant Medication

Introduction. Cerebral venous thrombosis (CVT) is a rare cerebrovascular condition involving multiple etiologies. Diagnosis of CVT is usually overlooked or delayed due to highly varied symptomatology, modes of onset and neuroimaging signs; furthermore, the same cause cannot be found in more than 15% of the cases, individual result being hard to predict, while the disease can complicate despite anticoagulant treatment. Material and methods. We present a typical case of meningitis that in day 10 of illness associated an uncommon symptomatology suggesting cerebral venous sinus thrombosis (CVST). Results. It should be noted that imaging examination can neither confirm nor exclude a thrombosis. A case whose development worsens progressively and for which there is no imaging exam to support a particular therapeutic conduct hampers the decision-making process for the physician. Discussion. The issue raised focuses on the assumption that anticoagulant medication may be beneficial to the patient or, on the contrary, it may be in the detriment of the physician who is uncertain about the diagnosis, due to subsequent unfavorable development of patient clinical status. Conclusions. That human rational thinking, exercised in years of experience, cannot yet be technologized, let alone replaced by a robot, and the existence of sets of rules for treatment incapable to ever cover the variety of features encountered in practice must always be doubted.

A review of therapeutic strategies for the management of cerebral venous sinus thrombosis

2009 ◽  
Vol 27 (5) ◽  
pp. E6 ◽  
Author(s):  
Ricky Medel ◽  
Stephen J. Monteith ◽  
R. Webster Crowley ◽  
Aaron S. Dumont
Keyword(s):  
Intracranial Hemorrhage ◽  
Mechanical Thrombectomy ◽  
Sinus Thrombosis ◽  
Case Reports ◽  
Case Series ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Level Of Evidence ◽  
Venous Sinus Thrombosis ◽  
Systemic Anticoagulation

Object Although initially described in the 19th century, cerebral venous sinus thrombosis (CVST) remains a diagnostic and therapeutic dilemma. It has an unpredictable course, and the propensity for hemorrhagic infarction produces significant consternation among clinicians when considering anticoagulation. It is the purpose of this review to analyze the evidence available on the management of CVST and to provide appropriate recommendations. Methods A thorough literature search was conducted through MEDLINE and PubMed, with additional sources identified through cross-referencing. A classification and level of evidence assignment is provided for recommendations based on the American Heart Association methodologies for guideline composition. Results Of the publications identified, the majority were isolated case reports or small case series. Few prospective trials have been conducted. Existing data support the use of systemic anticoagulation as an initial therapy in all patients even in the presence of intracranial hemorrhage. Chemical and/or mechanical thrombectomy, in conjunction with systemic anticoagulation, is an alternative strategy in patients with progressive deterioration on heparin therapy or in those who are moribund on presentation. Mechanical thrombectomy is probably preferred in patients with preexisting intracranial hemorrhage. Conclusions Effective treatments exist for the management of CVST, and overall outcomes are more favorable than those for arterial stroke. Further research is necessary to determine the role of individual therapies; however, the rarity of the condition poses a significant limitation.

scholarly journals Venous Strokes

2005 ◽  
Vol 18 (2_suppl) ◽  
pp. 61-66 ◽  
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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