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Rheolytic Thrombectomy for Cerebral Sinus Thrombosis

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Abstract

Introduction

Cerebral venous and sinus thrombosis (CVST) is an uncommon cause of stroke that is associated with poor outcomes in high-risk patients who present with stupor or coma, rapidly progressive neurologic deficits or progressive neurologic deficits during therapeutic anticoagulation.

Methods and Results

We report the rapid treatment of CVST in six patients at high risk for poor outcomes (death or dependency) using rheolytic thrombectomy combined with locally administered low-dose recombinant tissue plasminogen activator (rt-PA), and review the literature on rheolytic thrombectomy for CVST. All of the procedures were technically successful. No complications occurred. Two patients experienced partial rethrombosis following rheolytic thrombectomy requiring a second treatment. Preexisting hemorrhagic infarcts in two patients remained stable. Two of six patients experienced excellent clinical outcomes. Two had good outcomes. There were two deaths from irreversible cerebral injury caused by extensive CVST that had occurred prior to the endovascular treatments. In 24 cases of rheolytic thrombectomy for CVST that were reviewed from this series and previously published reports, the large majority of patients experienced good to excellent clinical outcomes.

Conclusions

Extensive CVST in high-risk patients can be rapidly fatal. Rheolytic thrombectomy combined with locally administered, low-dose recombinant tissue plasminogen activator (rt-PA) is a safe and effective endovascular method to rapidly recanalize the intracranial dural sinuses in high-risk patients with CVST.

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Authors and Affiliations

  1. Department of Neurosurgery, Jinan Central Hospital, Shandong University, Jinan, Shandong, 250013, P.R. China

    Aijun Zhang

  2. Department of Radiology, Interventional Neuroradiology Service, Hospital of the University of Pennsylvania, 2 Dulles Building-Room 219, Philadelphia, PA, USA

    Randi L. Collinson, Robert W. Hurst & John B. Weigele

Authors
  1. Aijun Zhang
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  2. Randi L. Collinson
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  3. Robert W. Hurst
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  4. John B. Weigele
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Corresponding author

Correspondence to John B. Weigele.

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Disclosure: The authors report no conflicts of interest.

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Zhang, A., Collinson, R.L., Hurst, R.W. et al. Rheolytic Thrombectomy for Cerebral Sinus Thrombosis. Neurocrit Care 9, 17–26 (2008). https://doi.org/10.1007/s12028-008-9058-y

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  • DOI: https://doi.org/10.1007/s12028-008-9058-y

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