Mechanical thrombectomy combined with recombinant tissue plasminogen activator thrombolysis in the venous sinus for the treatment of severe cerebral venous sinus thrombosis

The aim of the present study was to assess the effectiveness and safety of endovascular interventional therapy, which is mechanical clot disruption combined with intrasinus thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA), for severe cerebral venous sinus thrombosis (CVST). The records of eight patients with CVST confirmed by computed tomography, magnetic resonance imaging (MRI), magnetic resonance venography (MRV) and/or digital subtraction angiography were analyzed. Of the eight cases, the Glasgow Coma Scale (GCS) scores were between 4 and 9 with a mean value of 8.3±2.7. All the patients had venous infarction and two cases had intracranial hemorrhagic infarcts. Mechanical clot destruction combined with intrasinus thrombolytic therapy with rt-PA was performed under general anesthesia. Intravenous heparin therapy and intracerebral pressure control were applied during this period. One patient succumbed and the other seven patients showed good treatment efficacy. The GCS scores of the seven patients reverted to 15 upon discharge from the Northern Jiangsu People's Hospital (Yangzhou, China). With regard to the modified Rankin score of the seven patients three months following surgery, six patients scored 0 and one patient scored 1. MRI and MRV follow-up examinations were performed for 3-15 months. Complete recanalization of the criminal sinus, which refer to the sinus attributable to the infarction or hemorrhage, was observed in five cases and partial recanalization was observed in two cases. Symptoms were monitored for 3-24 months and no recurrence was observed. Therefore, mechanical thrombectomy combined with intrasinus thrombolytic therapy with rt-PA is safe and effective for patients with severe CVST.