Local Thrombolysis for Severe Cerebral Venous Sinus Thrombosis

Guo, Xinbin; Guan, Sheng; Fan, Yuhua; Song, Lei

doi:10.3174/ajnr.a2932

Cited by 36 publications

(27 citation statements)

References 20 publications

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“…If the recanalization of thrombosed profound vessels sounds a reasonable goal to obtain a good outcome [24–26] as observed in our study, it is not clearly demonstrated yet. The ongoing randomized clinical trial (TO-ACT) comparing thrombolysis (with or without thrombosuction) + heparin therapy vs. heparin alone will perhaps answer this question [27].…”

Section: Discussionmentioning

confidence: 75%

Outcome of a cohort of severe cerebral venous thrombosis in intensive care

Soyer

Rusca

Lukaszewicz

et al. 2016

Ann. Intensive Care

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Background Severity of cerebral venous thrombosis (CVT) may require the transfer to intensive care unit (ICU). This report described the context for CVT transfer to ICU, the strategy of care and the outcome after 1 year.MethodsMonocentric cohort of 41 consecutive CVT admitted in a French ICU tertiary hospital (National Referent Center for CVT). Data collected are as follows: demographic data, clinical course, incidence of craniectomy and/or endovascular procedures and outcome in ICU, after 3 and 12 months.Results 47 years old (IQ 26–53), with 73.2 % were female, having a SAPS II 41 (32–45), GCS 7 (5–8), and at least one episode of mydriasis in 48.8 %. Thrombosis location was 80.5 % in lateral sinus and 53.7 % in superior sagittal sinus; intracranial hematoma was present in 78.0 %, signs of intracranial hypertension in 60.9 %, cerebral edema in 58.5 % and venous ischemia in 43.9 %. All patients received heparin therapy, and 9 cases had endovascular treatment (21.9 %); osmotherapy (53.7 %) and decompressive craniectomy (16 cases, 39 %) necessary to control intracranial hypertension. Ten patients/41 (24.4 %) died in ICU and 18/31 (58.1 %) were discharged from ICU with outcome 0–3 of mRS. After 12 months, 92 % of survivors (23/25) had a mRS between 0 and 3. The proportion of death was 31.7 % at 1 year.Conclusions The large proportion of acceptable outcome in survivors, which continue to functionally improve after 1 year, motivates the hospitalization in ICU for severe CVT. For similar CVT severity, craniectomy did not improve outcome in comparison with the absence of craniectomy.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0135-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 75%

Outcome of a cohort of severe cerebral venous thrombosis in intensive care

Soyer

Rusca

Lukaszewicz

et al. 2016

Ann. Intensive Care

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“…A total of thirty-five (35) published articles reporting data for patients receiving medical and endovascular therapies were selected for data abstraction. The number of articles for each study type was subcategorized: Individual case reports (CR) (13/35; 37.1%) (11,12,14,19, 21,26,28,31,33,35,37,39,41), case series (CS) (5/35; 14.2%) (13,18,20,25,40), retrospective reviews (RtR) (6/35; 17.1%) (16,22,29,30,36,38), systematic reviews of case reports/case studies (SR) (8/35; 22.8%) (4,5,8,15,17,23,24,34), and observational studies (PO) (3/35, 8.5%) (27,32,42). …”

Section: Resultsmentioning

confidence: 99%

“…Individual case reports (13/35; 37.1%) (11,12,14,19, 21,26,28,31,33,35,37,39,41), case series (5/35; 14.2%) (13,18,20,25,40), retrospective reviews (6/35; 17.1%) (16,22,29,30,36,38), and observational studies (3/35, 8.5%) (27,32,42) that were not otherwise mentioned or included in selected systematic reviews were included (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

“…Patients who had an increase in ICH after endovascular interventions were reported as ICH. 44 patients (14%) (22,25,27-30,38,41,42) in 9 articles at a rate of 13.2%, were reported to have intracranial hemorrhages, new or enlarging, after receiving endovascular thrombolysis or mechanical thrombectomy. Three articles did not specifically address intracranial hemorrhages post operatively (Figure 4) (21,32,35).…”

Section: Discussionmentioning

confidence: 99%

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New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments

Konakondla¹,

Schirmer²,

Li³

et al. 2017

Aging and disease

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Dural venous sinus thrombosis (DVST) is a rare cause of stroke, which typically affects young women. The importance of identifying pre-disposing factors that lead to venous stasis lies in the foundation of understanding the etiology, pathophysiology and clinical presentation. The precise therapeutic role of interventional therapies is not fully understood though the current data do suggest potential applications. The aim of the study was to perform a systematic review and meta-analysis to evaluate the utility of and short-term 30-day survival after endovascular therapy for patients with DVST. Standard PRISMA guidelines were followed. Data sources included PubMed keywords and phrases, which were also incorporated into a MeSH search to yield articles indexed in Medline over a 5-year period. All RCTs, observational cohort studies, and administrative registries comparing or reporting DVST were included. Sixty-six studies met inclusion criteria. 35 articles investigating treatment in a summation of 10,285 patients were eligible for data extraction and included in the review of treatment modalities. A total of 312 patients were included for statistical analysis. All patients included received endovascular intervention with direct thrombolysis, mechanical thrombectomy or both. 133 (42.6%) patients were documented to have a neurologic decline, which prompted endovascular intervention. All patients who had endovascular interventions were those who were started on and failed systemic anticoagulation. 44 patients were reported to have intracranial hemorrhages after intervention. Regardless of systemic anticoagulation, patients were still reported to have complications of VTE and PE. Primary outcome at 3-6 month follow up revealed mRS<1 in 224 patients. DVST presents with many diagnostic and therapeutic challenges. The utility of invasive interventions such as local thrombolysis and mechanical thrombectomy is not fully understood. It is exceedingly difficult to conduct large randomized trials for this low incidence disease process with large pathophysiological heterogeneity.

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“…Although no randomized trials exist, data from an adult series indicate that favorable outcomes can be achieved in over 90% of patients 10. The role of endovascular techniques in pediatric patients has been less frequently reported.…”

Section: Discussionmentioning

confidence: 99%

Combined use of Solitaire FR and Penumbra devices for endovascular treatment of cerebral venous sinus thrombosis in a child

Shaikh

Pukenas

McIntosh

et al. 2014

J NeuroIntervent Surg

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A pre-teenager with newly diagnosed ulcerative colitis presented to an emergency department with acute headache, altered mental status and bilateral lower extremity weakness. Head CT demonstrated acute thrombus in the vein of Galen and straight sinus, and the patient was started on a heparin infusion. The patient clinically deteriorated and became unresponsive. In view of the rapid deterioration despite anticoagulation therapy, the patient was taken for endovascular treatment. A novel endovascular approach was performed with combined use of Solitaire FR and Penumbra devices to enhance access to the straight sinus and to limit intraprocedural blood loss. The post-treatment head CT demonstrated a decrease in hyperattenuation within the vein of Galen and straight sinus. The neurologic status improved within 24 h. The patient was discharged home with a normal neurologic examination.

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Local Thrombolysis for Severe Cerebral Venous Sinus Thrombosis

Cited by 36 publications

References 20 publications

Outcome of a cohort of severe cerebral venous thrombosis in intensive care

Outcome of a cohort of severe cerebral venous thrombosis in intensive care

New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments

Combined use of Solitaire FR and Penumbra devices for endovascular treatment of cerebral venous sinus thrombosis in a child

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