Endovascular treatment of extensive cerebral sinus thrombosis

Abstract

Cerebral venous and sinus thrombosis is an uncommon but potentially lethal event. Although thrombosis accounts for only 1% of all strokes, if it is left untreated patients suffer from continuing headaches, vague neurological complaints, and may even progress to coma and death. New endovascular techniques and technology allow the possibility of more aggressive thrombolysis and thrombectomy in the setting of acute thrombosis. The authors present a case of recanalization of an extensive cerebral thrombosis using a new endovascular retrieval device.

Local Thrombolysis for Severe Cerebral Venous Sinus Thrombosis

“…The largest case series included 20 patients with intrasinus thrombolysis. [7][8][9][10] In our study, local urokinase was relatively well tolerated in 35 patients. Recanalization was documented in 35 patients receiving urokinase.…”

From presentation to follow-up: diagnosis and treatment of cerebral venous thrombosis

“…Most agree that systemic intravenous anticoagulation is an appropriate first-line therapy, even in the presence of intracranial hemorrhage, and this will be sufficient for the majority of cases. 41,49 The decision on how to best to proceed in treating patients stems from clinical or radiological severity. The presence of poor prognostic risk factors, rapid deterioration, failure of a treatment modality, significant clot burden, or signs of impending herniation warrant more aggressive and invasive treatments.…”

“…Since clots themselves are thrombogenic, use of anticoagulation attenuates propagation, significantly reducing the burden that must be overcome by the venous system. 41 Even in cases in which hemorrhage was detected, anticoagulation has repeatedly been shown to be safe and effective. A commonly used regimen is a bolus dose of up to 1000 U, followed by low-dose maintenance therapy at 400-600 U/hour to an activated partial thromboplastin time of 60-70 seconds.…”

“…Gelfoam is used to seal the sinus, and the bone flap is replaced. 10,11,18,29,41,42,46 Mechanical thrombectomy with a rheolytic catheter resulted in clinical improvement in 75% of patients. One major advantage of this therapy is the immediate angiographic restoration of flow.…”

Treatment of Acute Ischemic Stroke: Beyond Thrombolysis and Supportive Care

“…The AngioJet catheter is a rheolytic thrombectomy catheter, which works by creating a vacuum to fragment and suction the thrombus through the catheter. The Merci clot retrieval device and/or the Penumbra device has also been reported to have achieved successful thrombectomy [64]. There have been no randomized controlled trials to support the use of mechanical catheters in this entity, but case series have been reported [65,66].…”