Stent retriever thrombectomy combined with long‑term local thrombolysis for severe hemorrhagic cerebral venous sinus thrombosis

Intracranial complications of sinusitis are rare but life threatening. We present a case of a 17-year-old woman with sinusitis who deteriorated over the course of 12 days from subdural empyema and global purulent cerebral venous sinus thrombosis. The patient was managed with surgery and mechanical thrombectomy utilizing a novel ‘stent anchor with mobile aspiration technique’, in which a Trevo stent retriever (Stryker) was anchored in the superior sagittal sinus (SSS) while a 5 MAX ACE reperfusion catheter (Penumbra) was passed back and forth from the SSS to the sigmoid sinus with resultant dramatic improvement in venous outflow. The patient was extubated on postoperative day 3 and was discharged with minimal lower extremity weakness on postoperative day 11. This is the first report using the Trevo stent retriever for sinus thrombosis. It is important to keep these rare complications in mind when evaluating patients with oral and facial infections.

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Quality of Life in Patients with Cerebral Venous Sinus Thrombosis: A Study on Physical, Psychological, and Social Status of Patients in Long-term

Archives of Iranian Medicine ◽

10.34172/aim.2021.03 ◽

2021 ◽

Vol 24 (1) ◽

pp. 15-21

Author(s):

Danesh Kajbaf ◽

Kamyar Moradi ◽

Hossein Shamshiri ◽

Sayna Bagheri ◽

Reza Rikhtegar ◽

...

Keyword(s):

Quality Of Life ◽

Sinus Thrombosis ◽

Linear Regression Analysis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Time Interval ◽

Residual Symptoms ◽

Venous Sinus Thrombosis

Background: Cerebral venous sinus thrombosis (CVST) causes significant problems for patients in the working age and may therefore negatively affect their quality of life (QOL). In the present study, we sought to evaluate the QOL and its predictors in subjects with CVST. Methods: This observational, prospective study investigated several outcomes of 56 CVST patients after thrombosis onset. Demographic characteristics, medical history, neurological signs and symptoms during hospitalization, and the employment status of the patients were retrospectively collected. Stroke-related functional scales, including the modified Rankin Scale (mRS) and Barthel Index (BI) were employed. For physical and mental aspects of the QOL, we used the validated Persian version of the Stroke Specific Quality of Life (SS-QOL) scale. Results: The physical and functional outcomes in the long-term were promising according to mRS and BI tools, as well as the improved rate of return to work. Mental domains of the SS-QOL, such as energy and personality represented the lowest scores. According to the multiple linear regression analysis, lower mRS score, and longer time interval between CVST onset and interview were associated with higher physical function of the patients while their better mental function was correlated with lower mRS score and thrombosis in merely one cerebral venous. Conclusion: CVST patients experience an acceptable alleviation of the primary physical disabilities, while residual symptoms, mostly in psychologic/mental domains, impair their QOL.

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Long-term outcome of cognition and functional health after cerebral venous sinus thrombosis

Neurology ◽

10.1212/wnl.54.8.1687 ◽

2000 ◽

Vol 54 (8) ◽

pp. 1687-1689 ◽

Cited By ~ 50

Author(s):

S. F. T. M. de Bruijn ◽

M. Budde ◽

S. Teunisse ◽

R. J. de Haan ◽

J. Stam

Keyword(s):

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Functional Health ◽

Term Outcome ◽

Long Term Outcome ◽

Venous Sinus Thrombosis

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

Interventional Neuroradiology ◽

10.1177/1591019917730335 ◽

2017 ◽

Vol 23 (6) ◽

pp. 605-608 ◽

Cited By ~ 5

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.

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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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