Efficacy of Stent Thrombectomy Alone or Combined With Intermediate Catheter Aspiration for Severe Cerebral Venous Sinus Thrombosis: A Case-Series

Abstract

ObjectiveTo assess the safety and efficacy of stent thrombectomy alone or combined with intermediate catheter aspiration for severe cerebral venous sinus thrombosis.MethodWe retrospectively collected the clinical data of 7 patients with severe CVST who received endovascular treatment at our hospital from January 2017 to June 2020. The patients had at least one adverse prognostic factor (mental status disorder, comatose state, intracerebral hemorrhage, or thrombosis of the deep venous system).ResultsThe median age was 51 years. Three patients were women. Two or more venous sinuses were in involved in 5 patients. All patients received systemic anticoagulant therapy before endovascular therapy. Neurological deterioration was the main reason for patients with cerebral venous sinus thrombosis undergoing intravascular therapy. The median time from admission to intravascular therapy was 3 days (1–9 days). Primary endpoints: 6 patients (85.7%) had a modified Rankin scale score of 0 at day 90, and 1 patient (14.3%) had a modified Rankin scale score of 2 at day 90. Secondary endpoints: complete recanalization was achieved in 4 cases (57.1%) and partial recanalization in 3 cases (42.9%).ConclusionStent thrombectomy, combined with intermediate catheter aspiration, balloon dilation, and regional thrombolysis/anticoagulation treatment, is an effective strategy to treat severe cerebral venous sinus thrombosis patients who had inadequate response to anticoagulant therapy. This strategy can quickly eliminate the occluded venous sinus and improve prognosis of severe cerebral venous sinus thrombosis.

Endovascular Treatment of Intracranial Vein and Venous Sinus Thrombosis—A Systematic Review

“…Prospective case series, retrospective analyses and case series demonstrated the technical and procedural feasibility and safety of EVT in selected patients ( n = 19; details in Table 1 ) [ 19 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ]. All reported patients were anticoagulated, and those with an expected poor prognosis (such as ICH or edema, neurological deterioration, coma (e.g., GCS < 9), progressive thrombus material observed on repeated imaging or signs of elevated intracranial pressure (e.g., papilledema)).…”

“…Retrospective and anecdotal data have demonstrated the safety and feasibility of EVT in selected patients, and have shown satisfying results [ 19 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ]. Yet, because of their lack of a control group and their retrospective nature, those studies have been unable to demonstrate a treatment effect resulting in an outcome benefit.…”

“…Various treatment strategies have been investigated in EVT for SVT. Local thrombolytic therapy (urokinase or alteplase) was performed in most of the cases [ 19 , 38 , 39 , 40 , 41 , 42 , 44 , 45 , 46 , 47 , 48 , 49 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ], with either a single periinterventional bolus or a continual infusion (locally, via a microcatheter) for up to 72 h (or longer, depending on the recanalization success). Yue et al (2010) combined intraarterial thrombolysis with an endovascular thrombectomy approach (balloon-guided) [ 57 ].…”

“…Yue et al (2010) combined intraarterial thrombolysis with an endovascular thrombectomy approach (balloon-guided) [ 57 ]. Several thrombectomy procedures were discussed in the presented literature: aspiration thrombectomy [ 19 , 38 , 39 , 40 , 41 , 42 , 46 , 48 , 49 , 51 , 53 , 54 , 55 , 56 ], stent retriever thrombectomy [ 38 , 39 , 40 , 41 , 42 , 46 , 47 , 48 , 49 , 54 ], balloon-guided thrombectomy/angioplasty [ 19 , 38 , 39 , 40 , 41 , 44 , 47 , 51 , 53 , 54 , 57 ], the (rheolytic) AngioJet device [ 38 , 39 , 40 , 47 , 49 , 50 ] as well as additional stenting [ 42 , 46 ]. The study by Dashti et al was the only one performing thrombectomy without local thrombolysis (AngioJet) [ 50 ].…”

“…In addition, several endovascular techniques have been discussed and investigated: rheolytic catheter thrombectomy, direct aspiration thrombectomy, balloon-guided thrombectomy or angioplasty and stent retriever thrombectomy [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. Information on EVT in SVT is sparse and is based primarily on case series and anecdotal data and only a single published randomized controlled trial (RCT) [ 19 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ]. Therefore, the current guideline recommendations remain vague.…”