Use of Mechanical Thrombolysis via Microballoon Percutaneous Transluminal Angioplasty for the Treatment of Acute Dural Sinus Thrombosis: Case Presentation and Technical Report

Abstract

This report shows the feasibility of performing safe and effective mechanical thrombolysis with percutaneous transluminal angioplasty coronary balloon microcatheters within the major dural sinuses. This technique can probably accelerate clot disruption and thrombolysis, possibly resulting in a more rapid restoration of venous flow.

Mechanical Thrombolysis for Treatment of Acute Sinus Thrombosis-Case Report-

“…Previously, mechanical thrombolysis was exclusively performed for patients with severe manifestations (Table 1). 1,4,6,[8][9][10][11] Fibrin is the main component of the thrombus responsible for sinus thrombosis. Local thrombolytic therapy with fibrinolytic agents, such as urokinase and recombinant tissue plasminogen activator, is performed as a proactive treatment for sinus thrombosis.…”

“…Mechanical thrombolysis includes rheolytic thrombectomy, which breaks up and aspirates the thrombus using the negative pressure created by the Venturi effect, 10) and mechanical thrombolysis (as used in our patient), which uses a balloon catheter to break up the thrombus. 1,4,9) As much as 200,000-20,000,000 IU of urokinase are required to achieve complete thrombolysis. 4) Concomitant mechanical thrombolysis allows administration of a lower dose of fibrinolytic agents than used by only pharmacological thrombolysis, so reduces the risk of hemorrhage related to the fibrinolytic agents.…”

“…1,4,9) As much as 200,000-20,000,000 IU of urokinase are required to achieve complete thrombolysis. 4) Concomitant mechanical thrombolysis allows administration of a lower dose of fibrinolytic agents than used by only pharmacological thrombolysis, so reduces the risk of hemorrhage related to the fibrinolytic agents. We performed mechanical thrombolysis using a balloon catheter prior to pharmacological thrombolysis, so we could use a low dose of urokinase (240,000 IU).…”

Interventional neuroradiology

“…Heparin is usually continued post-procedure and the patient subsequently receives warfarin. Pharmacomechanical thrombolysis, which increases the surface area of thrombus exposed to thrombolytic agent, may also be achieved using a balloon catheter [71][72][73] or microsnare 73 device. The latter is a microcatheter with a wire loop at the end which can be extruded and retracted back into the catheter, so macerating the thrombus.…”

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

“…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.…”