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Continuous thrombolysis and repeated thrombectomy with the Penumbra System™ in a child with hemorrhagic sinus thrombosis: technical note

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Abstract

Summary

Cerebral venous sinus thrombosis (CVST) is an uncommon but potentially lethal event. When showing a malignant clinical course despite anticoagulant therapy, new endovascular techniques and technology allow the possibility of more aggressive thrombolysis and thrombectomy. The authors present a case of recanalization of an extensive cerebral thrombosis using a new endovascular thromboaspiration device, the Penumbra System™.

Background and purpose

CVST in children is a rare but potentially lethal disorder. When showing a malignant progression despite anticoagulant therapy, the use of local thrombolytics and thrombectomy procedures might provide therapeutic solution.

Methods

A 16-year-old girl presented with signs and symptoms of a hemorrhagic cerebral sinus thrombosis and showed progression despite full dose anticoagulant therapy. The evolution being attributed to increasing mass effect, decompressive surgery was performed without clinical improvement. Further brain imaging demonstrated progression of the sinus thrombosis. Repeated local thrombectomy with the Penumbra thrombectomy system and continuous, relatively low dose local thrombolysis was performed during a period of 60 h, resulting in recanalization and clinical improvement. The methodology of combined thromboaspiration and thrombolysis is described.

Conclusions

We present a novel method for revascularization using the Penumbra System™ in combination with long-term, relatively low dose thrombolysis, in the setting of both clinically and morphologically progressive, hemorrhagic sinus thrombosis. The procedure proved to be both safe and effective and may be considered in the future for patients with progressive sinovenous thrombosis despite adequate medical therapy.

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Authors and Affiliations

  1. Department of Interventional Neuroradiology, National Neuroscience Institute, Budapest, Hungary

    Zsolt Kulcsár, Miklós Marosfői, Zsolt Berentei & István Szikora

  2. Neurozentrum, Klinik Hirslanden, Witellikerstrasse 40, 8032, Zurich, Switzerland

    Zsolt Kulcsár

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  1. Zsolt Kulcsár
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  2. Miklós Marosfői
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  3. Zsolt Berentei
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  4. István Szikora
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Correspondence to Zsolt Kulcsár.

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Kulcsár, Z., Marosfői, M., Berentei, Z. et al. Continuous thrombolysis and repeated thrombectomy with the Penumbra System™ in a child with hemorrhagic sinus thrombosis: technical note. Acta Neurochir 152, 911–916 (2010). https://doi.org/10.1007/s00701-009-0570-4

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  • DOI: https://doi.org/10.1007/s00701-009-0570-4

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