Endovascular Treatment of Acute Thrombosis of Cerebral Veins and Sinuses

Yakovlev, S B; Bocharov, A; Mikeladze, K G; Gasparian, S. S.; Serova, N K; Shakhnovich, A. R.

doi:10.15274/nrj-2014-10066

Cited by 9 publications

(10 citation statements)

References 19 publications

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“…Individual case reports (13/35; 37.1%) (11,12,14,19, 21,26,28,31,33,35,37,39,41), case series (5/35; 14.2%) (13,18,20,25,40), retrospective reviews (6/35; 17.1%) (16,22,29,30,36,38), and observational studies (3/35, 8.5%) (27,32,42) that were not otherwise mentioned or included in selected systematic reviews were included (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

“…A total of thirty-five ( 35 ) published articles reporting data for patients receiving medical and endovascular therapies were selected for data abstraction. The number of articles for each study type was subcategorized: Individual case reports (CR) (13/35; 37.1%) ( 11 , 12 , 14 , 19 , 21 , 26 , 28 , 31 , 33 , 35 , 37 , 39 , 41 ), case series (CS) (5/35; 14.2%) ( 13 , 18 , 20 , 25 , 40 ), retrospective reviews (RtR) (6/35; 17.1%) ( 16 , 22 , 29 , 30 , 36 , 38 ), systematic reviews of case reports/case studies (SR) (8/35; 22.8%) ( 4 , 5 , 8 , 15 , 17 , 23 , 24 , 34 ), and observational studies (PO) (3/35, 8.5%) ( 27 , 32 , 42 ). …”

Section: Resultsmentioning

confidence: 99%

“…Ten ( 10 ) more articles were excluded during data extraction due to non-primary data, and outdated or insufficient information. Twenty-five ( 25 ) articles that reported primary data for patients receiving medical and endovascular therapies remained for statistical analysis. …”

Section: Methodsmentioning

confidence: 99%

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New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments

Konakondla¹,

Schirmer²,

Li³

et al. 2017

Aging and disease

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Dural venous sinus thrombosis (DVST) is a rare cause of stroke, which typically affects young women. The importance of identifying pre-disposing factors that lead to venous stasis lies in the foundation of understanding the etiology, pathophysiology and clinical presentation. The precise therapeutic role of interventional therapies is not fully understood though the current data do suggest potential applications. The aim of the study was to perform a systematic review and meta-analysis to evaluate the utility of and short-term 30-day survival after endovascular therapy for patients with DVST. Standard PRISMA guidelines were followed. Data sources included PubMed keywords and phrases, which were also incorporated into a MeSH search to yield articles indexed in Medline over a 5-year period. All RCTs, observational cohort studies, and administrative registries comparing or reporting DVST were included. Sixty-six studies met inclusion criteria. 35 articles investigating treatment in a summation of 10,285 patients were eligible for data extraction and included in the review of treatment modalities. A total of 312 patients were included for statistical analysis. All patients included received endovascular intervention with direct thrombolysis, mechanical thrombectomy or both. 133 (42.6%) patients were documented to have a neurologic decline, which prompted endovascular intervention. All patients who had endovascular interventions were those who were started on and failed systemic anticoagulation. 44 patients were reported to have intracranial hemorrhages after intervention. Regardless of systemic anticoagulation, patients were still reported to have complications of VTE and PE. Primary outcome at 3-6 month follow up revealed mRS<1 in 224 patients. DVST presents with many diagnostic and therapeutic challenges. The utility of invasive interventions such as local thrombolysis and mechanical thrombectomy is not fully understood. It is exceedingly difficult to conduct large randomized trials for this low incidence disease process with large pathophysiological heterogeneity.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments

Konakondla¹,

Schirmer²,

Li³

et al. 2017

Aging and disease

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“…This device may be used in combination with local thrombolysis in order to avoid damaging the wall or trabeculae of the dural sinus [58,60]. The Penumbra System is a new-generation neuroembolectomy device helpful mainly in arterial thrombus extraction [14,61,62]. It uses a separator wire under vacuum suction in order to destroy the clot.…”

Section: Antithrombotic Treatmentmentioning

confidence: 99%

Cerebral Vein and Dural Sinus Thrombosis

Jianu¹,

Jianu²,

Munteanu³

et al. 2018

Ischemic Stroke of Brain

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Cerebral venous thrombosis (CVT) is an uncommon disorder in the general population. At least 1 risk factor can be identified in 85% of patients with CVT. Because of the high frequency of thrombophilia among patients with CVT, screening for hypercoagulable conditions should be performed. Two pathophysiological mechanisms contribute to their highly variable clinical presentation. Four major syndromes have been described: isolated intracranial hypertension, focal neurological abnormalities, seizures, and encephalopathy. Cavernous sinus thrombosis represents the single CVT which produces a characteristic clinical syndrome. Head Computed Tomography is the most frequently performed imaging study, but Magnetic Resonance Imaging of the head combined with Magnetic Resonance venography are the most sensitive studies. Acute phase therapy for CVT focuses on anticoagulation, management of seizures, increased intracranial pressure, and prevention of cerebral herniation. The majority of patients have a complete or partial recovery, however they have an increased incidence of venous thromboembolism. Clinical and imaging follow-ups 3-6 months after diagnosis are recommended to assess for recanalization.

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“…The pathophysiology of CVT implies (1) a rise in cerebral venous pressure that is secondary to diffuse cerebral sinus and cortical thrombosis, followed by blood-brain barrier disruption, vasogenic edema, and elevated intracranial pressure (ICP); (2) reduced cerebrospinal fluid (CSF) absorption from the subarachnoid spaces via the arachnoid villi structures because of venous thrombosis and subsequent intracranial hypertension [1,2,4]. These CVT mechanisms translate into clinical signs of intracranial hypertension [1,2,4] that may become refractory and eventually require surgical decompression or, more recently, endovascular therapy by way of in situ *Correspondence: alexandresimonin21@gmail.com 1 Neurosurgery, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Rue du Bugnon 21, Lausanne, Switzerland Full list of author information is available at the end of the article mechanical thrombectomy [3,[5][6][7][8][9][10]. Severe CVT is an infrequent cause of intensive care unit (ICU) admission and intracranial hypertension, and available data on brain monitoring are very limited.…”

Section: Introductionmentioning

confidence: 99%

Multimodal Regional Brain Monitoring of Tissue Ischemia in Severe Cerebral Venous Sinus Thrombosis

et al. 2019

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Background: Comatose critically ill patients with severe diffuse cerebral venous thrombosis (CVT) are at high risk of secondary hypoxic/ischemic insults, which may considerably worsen neurological recovery. Multimodal brain monitoring (MBM) may therefore improve patient care in this setting, yet no data are available in the literature. Methods: We report two patients with coma following severe diffuse CVT who underwent emergent invasive MBM with intracranial pressure (ICP), brain tissue oximetry (PbtO 2), and cerebral microdialysis (CMD). Therapy of CVT consisted of intravenous unfractionated heparin (UFH), followed by endovascular mechanical thrombectomy (EMT). EMT efficacy was assessed continuously at the bedside using MBM. Results: Despite effective therapeutic UFH (aPTT two times baseline levels in the two subjects), average CMD levels of lactate and glucose in the 6 h prior to EMT displayed evidence of regional brain ischemia. The EMT procedure was associated with a rapid (within 6 h) improvement in both CMD lactate (6.42 ± 0.61 4.89 ± 0.55 mmol/L, p = 0.02) and glucose (0.49 ± 0.17 vs. 0.96 ± 0.32 mmol/L, p = 0.0005). EMT was also associated with a significant increase in PbtO 2 (22.9 ± 7.5 vs. 30.1 ± 3.6 mmHg, p = 0.0003) and a decrease in CMD glutamate (12.69 ± 1.06 vs. 5.73 ± 1.76 μmol/L, p = 0.017) and intracranial pressure (ICP) (13 ± 4 vs. 11 ± 4 mmHg (p = 004). Patients did not require surgical decompression, regained consciousness, and were discharged from the hospital with a good neurological outcome (modified Rankin score 3 and 4). Conclusions: This study illustrates the potential utility of continuous bedside MBM in patients with coma after severe brain injury, irrespective of the primary acute cerebral condition. Despite adequate ICP and PbtO 2 control, the presence of CMD signs of regional brain cell ischemia triggered emergent EMT to treat CVT, which was associated with a significant and clinically relevant improvement of intracerebral physiology.

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Endovascular Treatment of Acute Thrombosis of Cerebral Veins and Sinuses

Abstract: SUMMARY -Acute thrombosis of cerebral veins and sinuses (ATCVS) is

Cited by 9 publications

References 19 publications

New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments

New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments

Cerebral Vein and Dural Sinus Thrombosis

Multimodal Regional Brain Monitoring of Tissue Ischemia in Severe Cerebral Venous Sinus Thrombosis

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