Successful Endovascular Treatment of Cerebral Venous Thrombosis With a Novel, Larger Aspiration Catheter (REACT): A Case Report

Cerebral venous thrombosis (CVT) is a rare clinical entity, with clinical presentations extending from headache and seizures to coma and death. For adults developing progressive neurological worsening despite adequate medical management, endovascular thrombolysis and/or mechanical thrombectomy may be considered as treatment options. We present one such patient with CVT who developed seizures and slipped into a coma, despite best medical management. A large-bore aspiration catheter was used as a standalone system for the endovascular procedure. The venous sinuses were successfully re-canalized. The patient was discharged a week later with a modified Rankin scale of 2. Studies show that endovascular thrombolysis used alone or in conjunction with thrombectomy for CVT has a higher risk of hemorrhagic complications. If we were to use mechanical thrombectomy devices (that are specifically designed for intracranial clot retrieval) as a stand-alone system, we would probably have better clinical outcomes with a lower risk of hemorrhagic complications.

Download Full-text

The use of new anticoagulants in cerebral venous thrombosis

10.5327/1516-3180.416 ◽

2021 ◽

Author(s):

Letícia Luísa Mattos ◽

Amanda Mendes Clemente Vilella

Keyword(s):

Venous Thrombosis ◽

Young Women ◽

Cerebral Venous Thrombosis ◽

Lower Risk ◽

Case Reports ◽

High Recovery ◽

Risk Of Bleeding ◽

New Anticoagulants ◽

Hemorrhagic Complications ◽

Primary Focus

Background: Cerebral venous thrombosis (CVT) is still documented as a rare disease that affects less than 1% of the population, mainly young women. Symptoms are nonspecific, easily confused with less severe pathologies, with a primary focus on headache, which requires attention and knowledge from professionals. The diagnosis is made possible by the use of complementary exams, when the diagnosis is made early, it is of high recovery. In case of late diagnosis or incorrect treatment, the sequelae may be irreversible. Objectives and methodology: to analyze the use of new anticoagulants (NOACs) in relation to treatment with warfarin in cases of CVT, through narrative review. Studies from the years 2015-2020 were used in the following databases: Pubmed, Scielo and Medline. Results: Studies from the last 5 years, composed mainly of case reports and multicentric analyzes, report non-inferiority of the outcome when treatments are compared or better outcome with NOACs due to the lower risk of bleeding. However, the European Stroke Organization in its last guideline (2017) does not recommend the use, especially during the acute phase. Conclusions: CVT can affect patients of various ages, so knowledge of the best therapy is essential. Currently, the use of warfarin and heparin is still recommended for acute cases, assessing the risk of complications such as bleeding. In view of the possible safety of new anticoagulants in view of the risk of hemorrhagic complications, further studies of non-inferiority in relation to warfarin are necessary so that the best approach is employed for these patients.

Download Full-text

Mechanical Thrombectomy for Life-Threatening Cerebral Venous Thrombosis: A Case Report

Case Reports in Neurology ◽

10.1159/000507343 ◽

2020 ◽

Vol 12 (Suppl. 1) ◽

pp. 63-69

Author(s):

Kar Foo Lau ◽

Tsun-Haw Toh ◽

Khairul Azmi Abdul Kadir ◽

Mei-Ling Sharon Tai ◽

Kay Sin Tan

Keyword(s):

Case Report ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Mechanical Thrombectomy ◽

Anticoagulation Therapy ◽

First Line ◽

Venous Flow ◽

Clinical Presentations ◽

Wide Range ◽

Life Threatening

Cerebral venous thrombosis (CVT) is a rare cause of stroke worldwide with a wide range of clinical presentations. Anticoagulation therapy has been regarded as the first line of management of CVT to prevent the progression of thrombosis and to re-establish the venous flow. We present a case of severe CVT who did not respond to conventional anticoagulation therapy but responded well to mechanical thrombectomy (MT). This report highlights the features of CVT to consider for early MT.

Download Full-text

1382 Medical management of Cerebral Venous Thrombosis: A study of routine practice in France

Journal of the Neurological Sciences ◽

10.1016/s0022-510x(05)81744-7 ◽

2005 ◽

Vol 238 ◽

pp. S451

Keyword(s):

Venous Thrombosis ◽

Medical Management ◽

Cerebral Venous Thrombosis ◽

Routine Practice

Download Full-text

Stent Reconstruction of Carotid Tonsillar Loop Dissection Using Telescoping Peripheral Stents

Interventional Neurology ◽

10.1159/000486457 ◽

2018 ◽

Vol 7 (3-4) ◽

pp. 189-195 ◽

Cited By ~ 1

Author(s):

Benjamin M. Zussman ◽

Bradley A. Gross ◽

William J. Ares ◽

Cynthia L. Kenmuir ◽

Gregory M. Weiner ◽

...

Keyword(s):

Internal Carotid ◽

Treatment Options ◽

National Institutes Of Health ◽

Modified Rankin Scale ◽

Endovascular Techniques ◽

Aspiration Thrombectomy ◽

Patient Demographics ◽

Clinical Presentations ◽

Scale Scores

Background: Endovascular treatment options for internal carotid artery (ICA) dissection with tandem intracranial occlusion are evolving. We report 2 cases of stent reconstruction of carotid loop dissections. Methods: Two patients with symptomatic ICA dissections of true 360° tonsillar loops and tandem intracranial occlusions were treated with manual aspiration thrombectomy (MAT) and telescoping Zilver self-expanding peripheral stents. Patient demographics, clinical presentations, endovascular techniques, and clinical outcomes were reviewed. Results: In both cases, MAT achieved modified Treatment in Cerebral Ischemia scale 2B reperfusion, and complete endovascular reconstruction of the dissected extracranial loop was performed. Both patients had improved pre- to postintervention National Institutes of Health Stroke Scale scores (16 to 0 and 14 to 0), and both had modified Rankin scale scores of 1 at 3-month follow-up. Conclusions: Stent reconstruction of complex cerebrovascular anatomy is increasingly feasible with advancements in stent technology and catheter support system design. This technique may be of use to neuroendovascular surgeons who encounter variant ICA anatomy.

Download Full-text