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

Abstract

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.

Clinical Observation and Value Analysis of Endovascular Interventional Therapy for Intracranial Venous Sinus Thrombosis

“…Although the widespread use of heparin and LMWH has greatly increased the chance of cure of this disease in recent years, data show that 5%-30% of patients still have a poor prognosis [ 26 – 28 ]. After CVST, reducing the increased venous pressure is very effective in improving the ischemic area involved in this disease and enhancing cerebral vascular perfusion.…”

Neutrophil extracellular traps promote thrombogenicity in cerebral venous sinus thrombosis

“…Due to a wide spectrum of clinical presentations, the misdiagnosis rate of CVST is relatively high. Moreover, CVST carries an approximate mortality rate of 6–10%, and the mortality rate of severe CVST is as high as 30% [ 4 , 5 ]. Therefore, it is urgent to elucidate the underlying mechanism of CVST.…”