Endovascular Treatment of Cerebral Venous Sinus Thrombosis and Insights into Intracranial Coagulopathy

Roh, David; Carroll, Jason J; Melmed, Kara; Elkind, Mitchell S.V.; Eisenberger, Andrew; Francis, Richard O.; Park, Soo‐Jin; Agarwal, Sachin; Claassen, Jan; Meyers, Philip M.

doi:10.1016/j.jstrokecerebrovasdis.2018.12.015

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…Clot burden was monitored with serial CTA and CTV; and on hospital day 5, tPA was begun, infusing through the microcatheter at a rate of 1 mg/h. [ 5 , 10 , 11 ] Daily CTA and CTV monitoring showed progressive increases in blood flow throughout the previously thrombosed deep venous system [ Figure 4 ]. [ 3 ] The microcatheter was removed on hospital day 8 following acceptable revascularization observed on CT imaging, and systemic heparin was restarted.…”

Section: Case Descriptionmentioning

confidence: 99%

Mechanical venous thrombectomy and prolonged infusion of tissue plasminogen activator for cerebral venous sinus thrombosis: Video case report

Housley

Vakharia

Waqas

et al. 2020

Surgical Neurology International

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Background: Cerebral venous sinus thrombosis (CVST) is a rare and often misdiagnosed condition with mortality rates ranging from 6 to 10%. Diagnosis and monitoring are typically achieved through noninvasive imaging, including computed tomography or magnetic resonance venography. The current standard of treatment is systemic anticoagulation. However, in patients who continue to decline neurologically or do not show sufficient response to or have absolute contraindications to systemic anticoagulation, endovascular treatments are an alternative. Endovascular options are poorly studied and specific devices have not been developed, partially due to the rare nature of the disease. Here, we present a case report detailing the treatment of extensive CVST from the vein of Galen to the sigmoid sinus using mechanical thrombectomy and local infusions of unfractionated heparin (UFH) and tissue plasminogen activator. Case Description: A 53-year-old man presented and was found to have extensive CVST extending from the vein of Galen to the left sigmoid sinus. Systemic UFH was begun; however, his condition continued to decline, and he was taken for endovascular intervention, wherein mechanical thrombectomy was undertaken using combinations of stent retrievers and balloon catheters, which provided acceptable revascularization. Unfortunately, his hospital course was further complicated by a cerebellar hematoma that was surgically evacuated and reocclusion of the sinus for which a microcatheter was placed for infusion of UFH and tissue plasminogen activator. Conclusion: Complicated CVST may require aggressive endovascular management. Local infusions of heparin and thrombolytic agents as well as mechanical thrombectomy are safe alternative options.

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Section: Case Descriptionmentioning

confidence: 99%

Mechanical venous thrombectomy and prolonged infusion of tissue plasminogen activator for cerebral venous sinus thrombosis: Video case report

Housley

Vakharia

Waqas

et al. 2020

Surgical Neurology International

View full text Add to dashboard Cite

show abstract

“…Although it has good sensitivity and specificity, it is an invasive examination. The clinical manifestations of CVST are atypical and prone to misdiagnosis and missed diagnosis, and the diagnosis and treatment of CVST are still a difficult problem for clinicians [7,8].…”

Section: Introductionmentioning

confidence: 99%

Clinical Features of Diffuse Leptomeningeal Glioneuronal Tumor With the First Symptom of Headache and Decreased Vision Misdiagnosed as Venous Sinus Thrombosis

Bao

Ding

et al. 2019

J Neurol Res

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Meningeal carcinoma has a variety of clinical manifestations and a high mortality and disability rate. Among them, cranial hypertension is one of the important causes of death, which is easy to be missed or misdiagnosed. The purpose of this case report is to describe the clinical features of diffuse leptomeningeal glioneuronal tumor (DNGNT) with the first symptom of headache accompanied by decreased vision misdiagnosed as venous sinus thrombosis. The patient initially suffered from headache and decreased vision, and rapidly developed blindness. According to the clinical manifestations and cerebrospinal fluid (CSF) examination results, the patient was initially misdiagnosed as venous sinus thrombosis, the intracranial pressure was relieved by Ommaya capsule, and the cerebrovascular condition was observed by magnetic resonance venogram (MRV) and digital subtraction angiography (DSA). The degree of meningeal enhancement was observed by enhanced magnetic resonance imaging (MRI), and meningeal cancer cells were found by CSF cytology. The patient was excluded from viral meningitis, tuberculous meningitis, cryptococcal meningitis, optic neuromyelitis, and central nervous system Behcet's disease by routine examination. Ommaya capsule implantation relieved the intracranial hypertension, and vision was restored after treatment. No venous sinus thrombosis was found in MRV and DSA; brain-enhanced MRI revealed extensive linear enhancement of the meninges, and CSF cytology revealed grotesque, actively dividing tumor cells; she was diagnosed as DLGNT. Meningeal carcinoma cannot be excluded in adolescents without tumor history. When patient has unexplained intracranial hypertension, it is necessary to consider DLGNT; early brain-enhanced MRI and CSF cytology are helpful for early diagnosis. For cranial hypertension, timely placement of Ommaya capsule can improve patient quality of life and save vision in time; molecular targeted therapy as early as possible can prolong survival.

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Endovascular Treatment of Cerebral Venous Sinus Thrombosis and Insights into Intracranial Coagulopathy

Cited by 4 publications

References 6 publications

Mechanical venous thrombectomy and prolonged infusion of tissue plasminogen activator for cerebral venous sinus thrombosis: Video case report

Mechanical venous thrombectomy and prolonged infusion of tissue plasminogen activator for cerebral venous sinus thrombosis: Video case report

Clinical Features of Diffuse Leptomeningeal Glioneuronal Tumor With the First Symptom of Headache and Decreased Vision Misdiagnosed as Venous Sinus Thrombosis

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