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.

Mechanical Thrombectomy for Cerebral Venous Sinus Thrombosis: A Case Series and Technical Note

2020 ◽  
Vol 140 ◽  
pp. 148-161
Author(s):  
Gorky Medhi ◽  
Subhendu Parida ◽  
Patrick Nicholson ◽  
Satya Bhusan Senapati ◽  
Bimal Prasad Padhy ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Sinus Thrombosis ◽  
Case Series ◽  
Cerebral Venous Sinus Thrombosis ◽  
Technical Note ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis

scholarly journals Balloon-Assisted Thrombectomy and Intrasinus Urokinase Thrombolysis for Severe Cerebral Venous Sinus Thrombosis

2021 ◽  
Vol 12 ◽  
Author(s):  
Jiansheng Yang ◽  
Hongyang Wang ◽  
Yanxing Chen ◽  
Minjian Qiu ◽  
Baorong Zhang ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Case Series ◽  
Cerebral Venous Sinus Thrombosis ◽  
Outcome Data ◽  
Venous Sinus ◽  
Technical Success ◽  
Venous Sinus Thrombosis ◽  
Contrast Enhanced ◽  
Systemic Anticoagulation

Background: Current clinical guidelines recommend systemic anticoagulation as the initial treatment for severe cerebral venous sinus thrombosis (CVST). However, anticoagulation alone does not always dissolve large and extensive CVSTs in some patients. Here, we investigated the effectiveness and safety of balloon-assisted thrombectomy and intrasinus urokinase thrombolysis in our retrospective study of a series of 23 patients with CVST.Methods: We reviewed the clinical, radiological, and outcome data of all patients. Complete recanalization was defined as all the occluded sinuses were recanalized on digital subtraction angiography or Contrast-enhanced magnetic resonance venography. Partial recanalization was defined as the complete recanalization of one sinus but persistent occlusion of other sinuses, or partial recanalization of one or more sinuses. The modified Rankin Scale (mRS) was used to represent the clinical outcome.Results: From May 2017 to November 2019, a total of 23 patients were treated with balloon-assisted thrombectomy and intrasinus urokinase thrombolysis. A total of 84 venous sinuses were involved, ≥3 sinuses were involved in 20 (87%) patients. Among them, 21 (91%) patients achieved technical success. Complete and partial recanalization were obtained in 17 (81%) and 4 (19%) patients at 6 months follow-up, respectively. All 21 patients had mRS scores of 0 (18) or 1 (3).Conclusions: Our case series shows that balloon-assisted thrombectomy combined with intrasinus urokinase thrombolysis and activated partial thromboplastin time-regulated systemic anticoagulation is safe and effective in treating severe CVST.

Safety and Validity of Mechanical Thrombectomy and Thrombolysis on Severe Cerebral Venous Sinus Thrombosis

Neurosurgery ◽  
2013 ◽  
Vol 72 (5) ◽  
pp. 730-738 ◽  
Author(s):  
Guangwen Li ◽  
Xianwei Zeng ◽  
Mohammed Hussain ◽  
Ran Meng ◽  
Yi Liu ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Treatment Modality ◽  
Mechanical Thrombectomy ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Magnetic Resonance Venography ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Digital Subtract Angiography

Abstract BACKGROUND: Although the majority of patients with cerebral venous sinus thrombosis (CVST) obtain an optimistic clinical outcome after heparin or warfarin treatment, there remains a subgroup of patients who do not respond to conventional anticoagulation treatment. These patients, especially younger people, as documented by hospital-based studies, have a high morbidity and mortality rate. OBJECTIVE: To verify the safety and efficacy of a dual mechanical thrombectomy with thrombolysis treatment modality option in patients with severe CVST. METHODS: Fifty-two patients diagnosed with CVST were enrolled and treated with mechanical thrombectomy combined with thrombolysis. Patients underwent urokinase 100 to 1500 × 103 IU intravenous sinus injection via a jugular catheter after confirming diagnoses of CVST by using either magnetic resonance imaging/magnetic resonance venography or digital subtract angiography. Information obtained on the patients included recanalization status of venous sinuses as evaluated by magnetic resonance venography or digital subtract angiography at admission, during operation, and at 3- and 6-month follow-up after treatment. RESULTS: The percentage of patients that showed complete and partial recanalization were 87% and 6%, respectively, after mechanical thrombectomy combined with thrombolysis treatment; 8% of the patients showed no recanalization. The modified Rankin Scale scores were 1.0 ± 0.9, 0.85 ± 0.63, and 0.37 ± 0.53 for discharge, and 3- and 6-month follow-up, respectively. A total of 6 patients died despite receiving aggressive treatment. No cases of relapse occurred after 3 to 6 months of follow-up. CONCLUSION: Thrombectomy combined with thrombolysis is a safe and valid treatment modality to use in severe CVST cases or in intractable patients that have shown no adequate response to antithrombotic drugs.

scholarly journals Cerebral venous sinus thrombosis complicated by subdural hematomas: Case series and literature review

2013 ◽  
Vol 4 (1) ◽  
pp. 85 ◽  
Author(s):  
PaulT Akins ◽  
YekaterinaK Axelrod ◽  
Cheng Ji ◽  
JeremyN Ciporen ◽  
SyedT Arshad ◽  
...  
Keyword(s):  
Literature Review ◽  
Sinus Thrombosis ◽  
Case Series ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Subdural Hematomas

scholarly journals Successful mechanical thrombectomy in a comatose patient with cerebral venous sinus thrombosis: A case report

2017 ◽  
Vol 23 (4) ◽  
pp. 437-440 ◽  
Author(s):  
Merel JJ Verhagen ◽  
Adriaan CGM van Es ◽  
Geert J Lycklama à Nijeholt ◽  
Korné Jellema ◽  
Jonathan Coutinho ◽  
...  
Keyword(s):  
Case Report ◽  
Alternative Treatment ◽  
Mechanical Thrombectomy ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Comatose Patient ◽  
Unfavourable Outcome ◽  
Treatment Methods ◽  
Venous Sinus Thrombosis

Cerebral venous sinus thrombosis is a rare cause of stroke, which is routinely treated with systemic heparin. Unfavourable outcome is often seen in severe cases. Therefore alternative treatment methods should be explored in these patients. Due to the risk of haemorrhagic complications, treatment without administration of thrombolytics is of particular interest. This report presents a case of successful mechanical thrombectomy, without the use of thrombolytics, in a comatose patient with cerebral venous sinus thrombosis.

Cerebral venous sinus thrombosis: a case series including thrombolysis

2009 ◽  
Vol 94 (10) ◽  
pp. 790-794 ◽  
Author(s):  
A A Mallick ◽  
P M Sharples ◽  
S E Calvert ◽  
R W A Jones ◽  
M Leary ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Case Series ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis
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