Endovascular treatment of cerebral venous thrombosis.

The article describes a clinical case of cerebral venous thrombosis involving the deep venous system in a 42-year-old patient suffering from acute lymphoblastic leukemia. As the patient’s condition progressively deteriorated despite anticoagulant therapy, endovascular treatment was attempted. Transvenous thrombectomy and local thrombolysis were performed, which made it possible to achieve only partial recanalization. Further prolonged administration of alteplase into the cerebral sinus through a microcatheter facilitated complete recanalization of the direct and transverse sinuses. The restoration of blood flow was accompanied by regression of neurological deficit. This case is discussed in the context of modern approaches to endovascular treatment of cerebral venous thrombosis.

Surgical Management of Acute Mesenteric Ischemia; Review Article

Mesenteric ischemia is a condition in which the amount of oxygen available is insufficient to meet the needs of the intestines. The small intestine, colon, or both can be affected by ischemia. The most common cause of occlusive ischemia is an abrupt obstruction of a major artery, which causes a considerable drop in intestinal blood flow. Early diagnosis is one of the most essential components in achieving a favorable outcome. The most prevalent treatment is surgical management. However, there are minimally invasive therapy alternatives that have been shown in observational studies. For arterial thrombosis, endovascular stenting is an option, and anticoagulation is an option for venous thrombosis. Endovascular aspiration, mechanical embolectomy, and local thrombolysis are all possibilities for patients with arterial embolism.

Local Thrombolysis in Acute and Extended Portal Vein and TIPS Thrombosis in a Patient with Decompensated Cirrhosis and Protein S Deficiency

This report describes the use of local thrombolysis using a tissue plasminogen activator in a case of a patient with refractory ascites referred for transjugular intrahepatic portosystemic shunt (TIPS) insertion. After successful TIPS insertion, the patient developed acute extended portal vein and TIPS thrombosis, which were treated with local thrombolysis using a tissue plasminogen activator, followed by the complete resolution of ascites. Although there are only limited published data of local thrombolysis for acute splanchnic vein thrombosis, we also review the relevance of the problem in the context of advanced liver disease.

Local Thrombolysis in High-Risk Pulmonary Embolism—13 Years Single-Center Experience

To evaluate the prognosis after local thrombolysis compared to systemic thrombolysis in high-risk pulmonary embolism. Observational study during 13 years which included 37 patients with high-risk pulmonary embolism treated with local thrombolysis and 36 patients with systemic thrombolysis (streptokinase, 250 000 UI/30 minutes followed by 100 000 UI/h). Cardiogenic shock has totally remitted in the group with local thrombolysis ( P = .002). The decrease in pressure gradient between right ventricle and right atrium was comparable in both groups in the acute period (the results being influenced by the higher in-hospital mortality after systemic thrombolysis), but significantly better in the next 24 months follow-up after in situ thrombolysis. Major and minor bleeding did not have significant differences. In hospital, mortality was significantly lower in the group with local thrombolysis ( P = .003), but for the next 24 months follow-up, the survival was comparable in both groups. Local thrombolysis, during the hospitalization, was associated with lower mortality rate comparing with systemic thrombolysis. In the next 24 months follow-up, the evolution of residual pulmonary hypertension was significantly better after in situ thrombolysis.