Direct thrombolysis for cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis (CVST) is an increasingly diagnosed disease with a wide range of symptoms, ranging from a mild headache to cerebral herniation. A potentially devastating syndrome, CVST has been associated with a mortality rate of 6–10%. In prospective studies, the overall rate of death and dependency from CVST ranges from 8.8 to 44.4%. Systemic anticoagulation remains the first-line treatment. However, a percentage of patients deteriorate despite medical therapy. These cases have resulted in the development of thrombolysis or endovascular treatment for CVST. Initial reports of the use of endovascular treatment of CVST have been promising. However, enthusiasm for the use of endovascular thrombolysis and thrombectomy should be tempered by an understanding of possible risks such as intracerebral hemorrhage and/or vessel dissection. The authors review the literature regarding endovascular treatment of CVST with a description of the chemical and mechanical thrombolytic techniques.

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Abstract 1122‐000212: INARI FlowTriever system: First Endovascular Clinical Experience to Treat Diffuse Cerebral Venous Sinus Thrombosis

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000212 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Samer Abdul Kareem ◽

Saif Bushnaq ◽

Nicholas Liaw ◽

Bader Alenzi ◽

Muhammad Khaleeq ◽

...

Keyword(s):

Endovascular Treatment ◽

Superior Sagittal Sinus ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Endovascular Techniques ◽

Venous Thrombectomy ◽

Venous Sinus Thrombosis ◽

Sagittal Sinus ◽

Clot Burden

Introduction : Cerebral Venous Sinus Thrombosis (CVST) is a rare stroke with a wide range of symptomatology at presentation ranging from headache, focal weakness, and coma. Anticoagulation remains the mainstay of treatment. However, in a subset of patients endovascular treatment can be potentially beneficial. Here we describe the first clinical experience using the INARI FlowTriever system to treat a patient presented with focal weakness and found to have diffuse cerebral venous sinus thrombosis. Methods : Case report of CSVT treated with INARI FlowTriever system. Results : A 78‐year‐old female with past medical history of Autoimmune hepatitis and hypothyroidism, was brought to the hospital with left arm weakness. CT head revealed left temporoparietal intraparenchymal hemorrhage and right frontal subarachnoid hemorrhage. CTA of the head and neck revealed extensive CVST involving superior sagittal sinus, bilateral transverse and sigmoid sinuses. She was started on heparin drip. Patient was taken for venous thrombectomy due to persistent left‐sided weakness and multicompartment bleeding while being on anticoagulation for 48 hours. She underwent successful endovascular venous thrombectomy using the INARI FlowTriever system with large clot burden extracted. She was switched to novel oral anticoagulation prior to discharge. During the 3 months follow‐up–MRI brain with and without contrast revealed near complete resolution of the clot burden in the superior sagittal sinus and left transverse/sigmoid complex and her modified Rankin score was at 0. Conclusions : Here we discussed a case of diffuse CVST who was treated initially with heparin drip then underwent endovascular venous thrombectomy using INARI FlowTriever system with large clot burden aspirated with a reasonable safety profile. The INARI medical FlowTriever system is the only mechanical thrombectomy system indicated for the treatment of pulmonary embolism. It is specifically designed for venous clots. It is composed of a trackable large bore aspiration catheter. The INARI FlowTriever Catheter; has 3 expanding nitinol mesh disks; designed to engage and disrupt venous clots and subsequently deliver it to the large bore aspiration catheter. Its larger size makes it an attractive candidate for venous sinus clot retrieval. This study illustrates the first clinical use of INARI thrombectomy device in CVST with a reasonable safety profile. Anticoagulation is the mainstay first line treatment for CVST. However, a small subset of patients would potentially benefit from endovascular treatment but it still uncertain how to select these patients and what is the best timeline to offer early endovascular treatment. Various neuro endovascular techniques has been attempted to treat cerebral venous sinus thrombosis. However; it is unclear which approach and device provides the optimal restoration of venous blood flow. Current neuro endovascular techniques and devices are not particularly designed for CVST pathology treatment and there is need for further innovation and new devices.

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

Fortschritte der Neurologie · Psychiatrie ◽

10.1055/s-0043-118098 ◽

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.

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Stenting for acute cerebral venous sinus thrombosis in the superior sagittal sinus

Interventional Neuroradiology ◽

10.1177/1591019915609120 ◽

2015 ◽

Vol 21 (6) ◽

pp. 719-723 ◽

Cited By ~ 15

Author(s):

Hidemitsu Adachi ◽

Yohei Mineharu ◽

Tatsuya Ishikawa ◽

Hirotoshi Imamura ◽

Shiro Yamamoto ◽

...

Keyword(s):

Endovascular Treatment ◽

Balloon Angioplasty ◽

Superior Sagittal Sinus ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Digital Subtraction ◽

Thrombus Aspiration ◽

Venous Sinus Thrombosis ◽

Sagittal Sinus

Endovascular treatment for superior sagittal sinus (SSS) thrombosis is not always successful because of difficult access and long thrombus lesions. We report the first two cases of patients with acute cerebral venous sinus thrombosis at the SSS that was not recanalized by anticoagulation, mechanical thrombectomy, or thrombolysis, but was successfully treated by stent placement. Case 1 was a 37-year-old woman with bilateral subdural hematomas. Digital subtraction angiography showed obstruction of the sinus from the SSS to the right transverse sinus. Recanalization was achieved by selective thrombolysis using urokinase followed by balloon angioplasty, but re-occlusion occurred on the next day of treatment. Repeated endovascular treatment including balloon angioplasty, thrombus aspiration and thrombolysis using recombinant tissue plasminogen activator failed to achieve recanalization. We thus placed intracranial stents in the SSS, which did achieve recanalization. Case 2 was a 69-year-old woman with a small infarction in the left parietal lobe. Digital subtraction angiography showed sinus obliteration from the SSS to the bilateral transverse sinuses. Recanalization was not achieved by balloon angioplasty, thrombus aspiration and selective thrombolysis. We thus placed intracranial stents in the SSS, which did achieve recanalization. Postoperative course was uneventful in both cases and venous sinus patency was confirmed by venography >1.5 years after treatment. When conventional endovascular strategies have been unsuccessful, placement of intracranial stents, which can easily gain access to the distal part of the SSS as compared with carotid stents, may be a useful treatment option for the acute sinus thrombosis in this region.

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1500 Endovascular treatment of cerebral venous sinus thrombosis in children: a scoping review

10.1136/archdischild-2021-rcpch.686 ◽

2021 ◽

Author(s):

Alex Fung ◽

George Hudson ◽

Shoomena Anil

Keyword(s):

Endovascular Treatment ◽

Scoping Review ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Venous Sinus Thrombosis

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Endovascular Technique of a Stent Device Combined With a Direct Aspiration Catheter for Endovascular Treatment and Pathological Examination of Clots in Cerebral Venous Sinus Thrombosis

Journal of Vascular Medicine & Surgery ◽

10.4172/2329-6925.1000307 ◽

2017 ◽

Vol 05 (02) ◽

Author(s):

Narihide Shinoda ◽

Yoji Kuramoto ◽

Shinya Hori ◽

Kazuyuki Mikami ◽

Toshiaki Bando ◽

...

Keyword(s):

Endovascular Treatment ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Pathological Examination ◽

Endovascular Technique ◽

Venous Sinus Thrombosis

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Clinical associations, biological risk factors and outcomes of cerebral venous sinus thrombosis

Journal of International Medical Research ◽

10.1177/0300060516664807 ◽

2016 ◽

Vol 44 (6) ◽

pp. 1454-1461 ◽

Cited By ~ 10

Author(s):

Hafize Nalan Gunes ◽

Burcu Gokce Cokal ◽

Selda Keskin Guler ◽

Tahir Kurtulus Yoldas ◽

Umit Yavuz Malkan ◽

...

Keyword(s):

Risk Factors ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Common Symptom ◽

Venous Sinus Thrombosis ◽

Hospitalization Period ◽

Wide Range ◽

Significant Difference ◽

Clinical Associations

Objective Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disease affecting young adults. The majority of the patients are female. The aim of this study is to assess the clinical associations, risk factors and outcomes of the patients with CVST. Methods The data of 75 patients with CVST admitted to our hospital between 2006 and 2016 were reviewed. Demographic and clinical features and the thrombophilic risk factors of the patients were recorded. The localizations of the thrombi were determined and modified Rankin score at the time of onset and discharge were calculated. Results The majority of our patients (78.7%) were female. Median age was 35 years (16–76). The most common symptom was headache (86.7%). In 82.6% of our patients, inherited or acquired risk factors for thrombosis were detected. Transverse sinus was the most common site of thrombosis followed by sigmoid and superior sagittal sinuses. Two thirds of the patients had involvement of multiple sinuses. The patients with the involvement of sagittal sinus had better disability at the time of admittance ( p = 0.013) while the number of involved sinuses was correlated worse disability ( p = 0.015). The neurologic states in the majority of the patients were improved by the end of the hospitalization period ( p = 0.001). There was no significant difference in disability score at discharge between men and women ( p = 0.080). No patient with CVST died in the hospitalization period. Conclusions This study is one of the largest cohort studies on CVST in our region. The results of the study disclosed that CVST had wide range of clinical manifestations and non-specific symptoms at the beginning. For that reason, in especially high risk groups for thrombosis, the diagnosis of CVST should be kept in mind.

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