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.

Aggressive treatment of cerebral venous sinus thrombosis (CVT) with stent retrievers and local thrombolysis: why we need a registry

2017 ◽  
Vol 85 (10) ◽  
pp. 605-610
Author(s):  
Christina Maria Kowoll ◽  
Hannah Lockau ◽  
Franziska Dorn ◽  
Christian Dohmen
Keyword(s):  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
First Line ◽  
Venous Sinus Thrombosis ◽  
Local Thrombolysis ◽  
First Line Therapy ◽  
Line Therapy ◽  
Limited Experience ◽  
Stent Retrievers

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.

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.

Local Thrombolysis for Severe Cerebral Venous Sinus Thrombosis

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

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 Heparin or Local Thrombolysis in the Management of Cerebral Venous Sinus Thrombosis?

2006 ◽  
Vol 12 (2) ◽  
pp. 131-140 ◽  
Author(s):  
S. Anand ◽  
W. Siddhartha ◽  
D.R. Karnad ◽  
M. Shrivastava ◽  
S. Ghatge ◽  
...  
Keyword(s):  
Likelihood Ratio ◽  
Sinus Thrombosis ◽  
Phase 1 ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Phase Iii ◽  
Clinical Grade ◽  
Venous Sinus Thrombosis ◽  
Intracranial Bleed ◽  
Three Phases

Patients with acute cerebral venous sinus thrombosis treated with Heparin or in situ thrombolysis in our department were evaluated in an attempt to rationalize treatment with heparin or thrombolysis. 279 patients with angiographically proven acute cerebral venous sinus thrombosis were included in the study. Patients were classified into mild and severe clinical grade. The study was divided into three phases. Phase I included 27 patients treated with systemic heparin. Phase II included 72 patients, 30 in severe grade and 42 in mild. 26 were thrombolysed with 14 in severe and 12 in mild grade. Phase III included 180 patients treated according to a defined protocol. 133 were in mild grade and 47 in severe. 67 patients were thrombolysed. In the thrombolysed group 27 patients were in mild grade and 40 in severe. 113 patients were treated with systemic heparin. Following acute management all were anticoagulated for six months. The baseline characteristics were found to be same in all three phases. On comparison of outcome in Phase III with Phase 1 the likelihood ratio was found to be statistically significant in favor of Phase III (p < 0.0001). The likelihood ratio was found to be statistically significant in mild and severe clinical grade in favor of thrombolysis in Phase III (p 0.039 in mild and p 0.00001 in Severe clinical grade). This ratio was insignificant (p = 0.716) for intracranial bleed; however, local puncture site bleeding was found to be significant in the thrombolysed group (0.00005).

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