T1-weighted Black-blood Magnetic Resonance Imaging Helps to Stage Thrombus on Segment Level and Predict the Outcome of Endovascular Therapy in Patients with Cerebral Venous Sinus Thrombosis

Abstract Purpose Clinical approach for staging cerebral venous sinus thrombosis (CVST) depends on the duration from symptom onset to clinical diagnosis, which is subjective and may be incorrect. To investigate if T1-weighted signal characteristics of the thrombus can be used for staging the thrombus on segment level and predicting endovascular therapy outcome. Methods Ninety-one CVST patients underwent non-contrast-enhanced T1-weighted 3D variable-flip-angle fast-spin-echo (T1-SPACE) and 29 of them received endovascular therapy. We divided the 91 patients into acute, subacute, and chronic CVST stage according to the clinical approach, and then analyzed the T1 weighted signal characteristics (i.e., thrombus shape and signal intensity) of the thrombus at each stage. To investigate the endovascular therapy outcome associated with the thrombus stage and signal characteristics, we evaluated the thrombolytic ratio on patient level and recanalization rate on segment level, respectively. Results The thrombi at acute or chronic stage were depicted as isointense signals but as hyperintense signals at subacute stage. Compared to the thrombus at acute stage, the thrombus at chronic stage was contractive and can be distinguished. Developing thrombi at transition periods of acute-to-subacute or subacute-to-chronic stage were found appearing mixed iso-/hyper-intense signals. On patient’s level, the patients at earlier stage had higher thrombolytic ratio (acute: 80.7 ± 18.3%, subacute: 62.6 ± 36.3%, chronic: 22.9 ± 24.2%). On segment level, the thromboembolic segments of isointense or mixed iso-/hyper-intense thrombi at non-chronic stage had good thrombolytic outcome. Conclusion T1-weighted signal characteristics of the thrombus can be used for staging CVST and predicting the endovascular therapy outcome.

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Successful endovascular therapy for an adolescent patient with cerebral venous sinus thrombosis

Medicine ◽

10.1097/md.0000000000027024 ◽

2021 ◽

Vol 100 (35) ◽

pp. e27024

Author(s):

Tao Peng ◽

Zini Zhang ◽

Bifeng Zu ◽

Bitang Dan

Keyword(s):

Endovascular Therapy ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Adolescent Patient ◽

Venous Sinus Thrombosis

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Endovascular Therapy Versus Anticoagulation for Treatment of Cerebral Venous Sinus Thrombosis

The Neurologist ◽

10.1097/nrl.0000000000000369 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Zhongmou Xu ◽

Xiang Li ◽

Dongxia Feng ◽

Tianyi Wang ◽

Xiang Xu ◽

...

Keyword(s):

Endovascular Therapy ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Venous Sinus Thrombosis

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Clinical Characteristics and Management of Cerebral Venous Sinus Thrombosis in Patients With Antiphospholipid Syndrome: A Single-Center Retrospective Study

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029621999104 ◽

2021 ◽

Vol 27 ◽

pp. 107602962199910

Author(s):

Huixin Shen ◽

Xiaoqin Huang ◽

Chunqiu Fan

Keyword(s):

Antiphospholipid Syndrome ◽

Endovascular Therapy ◽

Clinical Characteristics ◽

Sinus Thrombosis ◽

Transverse Sinus ◽

Cerebral Venous Sinus Thrombosis ◽

Good Prognosis ◽

Venous Sinus ◽

Initial Manifestation ◽

Venous Sinus Thrombosis

Antiphospholipid syndrome (APS) with cerebral venous sinus thrombosis (CVST) is a relatively rare phenomenon, and this observational study aimed to investigate the clinical characteristics of APS patients complicated with CVST. We retrospectively investigated the clinical characteristics of CVST events in APS and compared differential characteristics and associated factors between APS patients with and without CVST. Twenty-one CVST patients with APS were enrolled including 14 females (9.4%) and 7 males (5.8%). The median age and disease duration at onset of CVST was 33 years (IQR 28-48) old and 1.3 months (IQR 0.7-4), respectively. Among APS patients with CVST, 12 (57.1%) cases presented with neurologic symptoms of CVST as the initial manifestation. Onset of CVST was mainly chronic (52.4%). Headache (90.5%) was the most common neurological symptom. The common locations of CVST were transverse sinus (76.2%) and superior sagittal sinus (57.1%), with more frequently (76.2%) dual or multiple sinuses involved. All patients with CVST were treated with anticoagulant, and 5 (23.8%) patients received endovascular therapy. Sixteen (84.2%) patients had good outcomes and 3 (15.8%) patients died at last follow-up. There were no significant differences ( P > 0.05) between two groups in the analysis of related APS indicators. There were no significant differences ( P > 0.05) between two groups in the analysis of related APS indicators. Although APS complicated with CVST is rare and predominately chronic developed. The evaluation of CVST should be performed for APS patients with intracranial hypertension syndrome. The routine screening of antiphospholipid antibodies (aPLs) is highly recommended in unexplained CVST patients. Most CVST patients with APS will have a good prognosis after treatment, and endovascular therapy is an alternative treatment.

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Successful endovascular therapy for cerebral venous sinus thrombosis accompanied by heparin-induced thrombocytopenia

Interventional Neuroradiology ◽

10.1177/1591019919887821 ◽

2020 ◽

Vol 26 (3) ◽

pp. 341-345

Author(s):

Yoshihisa Fukushima ◽

Kenji Takahashi ◽

Ichiro Nakahara

Keyword(s):

Medical Treatment ◽

Endovascular Therapy ◽

Sinus Thrombosis ◽

Venous Drainage ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Heparin Induced Thrombocytopenia ◽

Venous Sinus Thrombosis ◽

Excellent Outcome ◽

Disturbance Of Consciousness

Introduction Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication of heparin exposure. A limited number of studies have reported cerebral venous sinus thrombosis accompanied by heparin-induced thrombocytopenia. Here, we present a case of successful endovascular therapy (EVT) without periprocedural heparinization in this situation. Case presentation A 47-year-old woman taking an oral contraceptive was admitted to our hospital with severe headache to be diagnosed as cerebral venous sinus thrombosis. Initially, she got improved by medical treatment with intravenous unfractionated heparin. However, she rapidly developed disturbance of consciousness and right hemiplegia due to cerebral venous sinus thrombosis accompanied by heparin-induced thrombocytopenia on the 14th hospital day. She underwent emergent EVT by immediate conversion of anticoagulation from heparin to argatroban. Despite a large clot burden, sufficient recanalization and anterograde venous drainage were re-established by combined EVT including aspiration, balloon sinoplasty, and local thrombolysis with urokinase infusion. She got improved immediately after the intervention and discharged home without any neurological sequelae after two months. Conclusion This unique case of cerebral venous sinus thrombosis worsened by occurrence of heparin-induced thrombocytopenia during the treatment finally resulted in excellent outcome highlights effectiveness of emergent endovascular intervention for critical cerebral venous sinus thrombosis resistant to initial medical treatment and of immediate establishment of effective anticoagulant strategy for both of heparin-induced thrombocytopenia and cerebral venous sinus thrombosis. Neuroendovascular therapy for cerebral venous sinus thrombosis using alternative argatroban to heparin for periprocedural anticoagulation might be safe and feasible.

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Efficacy of stenting in patients with cerebral venous sinus thrombosis-related cerebral venous sinus stenosis

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014328 ◽

2018 ◽

Vol 11 (3) ◽

pp. 307-312 ◽

Cited By ~ 8

Author(s):

Ke Li ◽

Ming Ren ◽

Ran Meng ◽

Yuchuan Ding ◽

Gary B Rajah ◽

...

Keyword(s):

Sinus Thrombosis ◽

Therapeutic Option ◽

Visual Disturbance ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Chronic Stage ◽

Venous Sinus Thrombosis ◽

Venous Stenting ◽

Long Term Study ◽

Sinus Stenosis

BackgroundVenous stenting has been proven to be a safe and effective therapeutic option for patients with idiopathic intracranial hypertension (IIH) and cerebral venous sinus stenosis (CVSS). However, its use in patients with cerebral venous sinus thrombosis-related CVSS has been less reported.PurposeTo explore the safety and efficacy of stenting for patients with cerebral venous sinus thrombosis (CVST)-related CVSS.MethodsThe clinical presentation, treatment, and outcome of patients with CVST-related CVSS received venous stenting in the chronic stage after failed medical treatment were retrospectively evaluated.ResultsA total of 17 patients with CVST-related CVSS were included. Mean pressure gradient across the CVSS decreased from 11.5±4.2 mmHg prior to stenting to 2.1±1.1 mmHg post- stenting. Mean CSF opening pressure decreased from 33.1±5.5 cmH2O to 18.7±1.7 cmH2O. Both headache and visual disturbance improved or resolved in 78% and 92% of the patients, respectively. Complications included lethal cerebellar hematoma in one case and bilateral occipital epidural hematoma in another case. One of the patients received retreatment with ventriculo-peritoneal shunting due to recurrent headache.ConclusionRestoring the patency of stenotic sinuses with stents in patients of CVST-related CVSS unresponsive to medical therapy in the chronic stage may improve symptoms in the majority of the patients. However, a relatively higher cerebral hemorrhage rate was observed and may be related to this pathology. Stenting in this subgroup of CVSS patients may require further evaluation with a larger and long-term study, and should be used with caution at this time.

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