Mechanical Thrombectomy with Intraoperative Local Thrombolysis Versus Mechanical Thrombectomy with Continuous Thrombolysis for Treatment of Cerebral Venous Sinus Thrombosis: A Systematic Review of 82 Cases

Chen, Cheng-Wei; Xu, Lijun; Huang, Lifa; Zhang, Jingru; Chen, Suihong; Ye, Hui; Yao, Qiang; Zhang, Tiehui; Zhang, Xin; Chen, Zupeng; Yang, Chao; Liang, Xiaolong

doi:10.1016/j.wneu.2018.12.193

Cited by 11 publications

(9 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Near to complete recanalization was documented in 100% of patients (complete recanalization in 41%), 82% of patients achieved a good outcome and, 4% of patients developed postoperative intracerebral hemorrhage. No significant differences were found in the recanalization rate or prognosis between compared endovascular therapeutic methods 42 . The optimal treatment approach remains uncertain in the rare subgroup of CVST affecting the deep venous system, leading to more frequent venous infarctions and parenchymal bleeding.…”

Section: Discussionmentioning

confidence: 79%

Factors influencing therapy choice and clinical outcome in cerebral venous sinus thrombosis

Krajíčková

Král

Herzig

et al. 2020

Sci Rep

View full text Add to dashboard Cite

We aimed was to assess the factors influencing therapy choice and clinical outcome after 3–4 months in patients with cerebral venous sinus thrombosis (CVST). In a retrospective, bi-centric study, the set consisted of 82 consecutive CVST patients (61 females; mean age 33.5 ± 15.7 years). Following data were collected: baseline characteristics, presence of gender-specific risk factors (GSRF), location and extent of venous sinus impairment, clinical presentation, type of treatment, recanalization, presence of parenchymal lesions, and clinical outcome after 3–4 months (assessed using the modified Rankin Scale [mRS], with excellent outcome defined as mRS 0–1). Multivariate logistic regression analysis was used for statistical evaluation. After 3–4 months, complete recovery was achieved in 41 (50%) and excellent clinical outcome in 67 (81.7%) patients. Female sex (OR 0.11; p = 0.0189) and presence of focal neurologic deficit (OR 0.16; p = 0.0165) were identified as significant independent negative predictors and, the presence of GSRF (OR 15.63; p = 0.0011) as significant independent positive predictor of excellent clinical outcome. In conclusion, in our CVST patients, the presence of GSRF was associated with excellent clinical outcome, while the female sex itself was associated with poorer clinical outcome.

show abstract

Section: Discussionmentioning

confidence: 79%

Factors influencing therapy choice and clinical outcome in cerebral venous sinus thrombosis

Krajíčková

Král

Herzig

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…In addition, in severe and potential fetal cases, heroic treatments, such as decompressive surgery and endovascular thrombolysis, might contribute to better prognosis (21,64,(66)(67)(68)(69)(70)(71). The risk stratification scores predict the poor prognosis for the identification of high-risk patients (78,79,81). Overall, with regard to the rarity of the disease and novelty of the therapeutic approaches, there is a long way to fully identify the best diagnostic and therapeutic approaches to the disease.…”

Section: Resultsmentioning

confidence: 99%

“…Nevertheless, the main dilemma in endovascular heroic treatment approach includes how to define what considered the failure of conservative treatment and consequently determine the patients who are candidates for endovascular treatment and optimal endovascular approach (81). Another aspect of the treatment is focused on seizure management.…”

Section: Jvandcmentioning

confidence: 99%

An Update on Diagnosis and Treatment of Cerebral Venous Thrombosis in Adults: A Narrative Review

Paybast

Aghamiri

2020

J Vessel Circ

View full text Add to dashboard Cite

Background and Aim: Cerebral venous thrombosis (CVT) is a relatively common disorder of the cerebral venous system accounting for less than 1% of all strokes with a higher prevalence in Iran. Despite the considerable advances in recent years, the diagnosis and treatment of CVT are still challenging predominantly in the emergency setting. Therefore, the present study sought to provide an update on the diagnosis and treatment of CVT. Materials and Methods: PubMed, Web of Science, Google Scholar, Scopus, Elsevier, and Iranian domestic scientific databases were searched within January 1, 2000, to July 1, 2020. In all the electronic databases, the keywords (in the title/abstract) of "cerebral vein thrombosis" OR "CVT" OR "Cerebral venous sinus thrombosis" OR "CVST" AND "risk factor", "diagnosis", "treatment", and "prognosis" were searched. The unrelated articles, studies not concerning humans or pediatric population, and case reports were excluded from the study. In addition, the articles related to CVT in association with coronavirus disease 2019 infection were excluded from the present review. Results: According to the findings of the present study, the diagnosis of CVT might be delayed due to a wide range of clinical manifestations from a subacute headache with or without the signs of intracranial hypertension to the acute focal neurologic deficit and even loss of consciousness. Although the diagnosis is typically based on brain magnetic resonance imaging and magnetic resonance venography, there has been evidence suggesting that the plain computed tomography markers with an attenuation value of > 60.4 Hounsfield unit (HU) and Hounsfield-hematocrit (H: H) ratio of > 1.42 are specific enough for the diagnosis regardless of confirmatory imaging, such as venography. Additionally, the usefulness of D-dimer is still debatable, and an unacceptable false-negative rate of up to 26% has been illustrated. In terms of therapeutic aspects, although warfarin is still the mainstay of treatment, there has been increasing interest in new oral anticoagulants with promising results in both thrombus recanalization and excellent functional recovery. Balloon angioplasty and mechanical thrombectomy might also be considered in severely progressive cases without response to conventional treatments. It is worth mentioning that even for those achieving favorable outcomes, CVT can remain a disabling condition leading to at least neuropsychiatric complaints. Conclusion: The CVT is a rare and important cause of stroke accounting for less than 5% of all strokes mainly affecting young females. With regard to the rarity of the disease and novelty of the therapeutic approaches, there is a long way to fully identify the best diagnostic and therapeutic approaches to the disease.

show abstract

“…UK is the most frequently used agent (30). In most of the previous studies, it was used at doses of 250,000-1,000,000 U in one session during endovascular intervention (11,13,29,31), or as a continuous local infusion over several days. Local thrombolysis further dissolves residual thrombi and cortical venous thrombosis (10).…”

Section: Discussionmentioning

confidence: 99%

“…Anticoagulation or thrombolytic therapy alone may lead to further aggravation of the hematoma in those SH-CVST cases. Stent retriever thrombectomy combined with long-term local thrombolysis (SRT-LLT) has been used in certain centers for those refractory cases or patients with new intracranial hemorrhage (11)(12)(13). However, to date, no studies have reported on SRT-LLT treatment specifically for SH-CVST.…”

Section: Introductionmentioning

confidence: 99%

Stent retriever thrombectomy combined with long‑term local thrombolysis for severe hemorrhagic cerebral venous sinus thrombosis

et al. 2020

View full text Add to dashboard Cite

Cerebral venous sinus thrombosis (CVST) is a rare disease associated with high disability and mortality rates. A subset of patients do not respond to standard anticoagulation therapy, leading to the progression of CVST with hemorrhagic stroke, which represents a major challenge for its treatment. Severe hemorrhagic (SH)-CVST is life-threatening due to large hematoma, edema and/or cerebral hernia. Anticoagulation or thrombolytic therapy alone may lead to further aggravation of the hematoma. Stent retriever thrombectomy combined with long-term local thrombolysis (SRT-LLT) has been used in certain centers for those refractory cases or patients with new intracranial hemorrhage. However, to date, no studies on SRT-LLT treatment specifically for SH-CVST have been performed. The aim of the present retrospective study was to specifically evaluate the effectiveness of SRT-LLT in SH-CVST. Between December 2013 and November 2018, SRT-LLT was performed at our center in 8 patients with hemorrhagic CVST who did not respond to intravenous anticoagulation. The clinical characteristics, results of the radiological evaluation, details on the surgical procedure and clinical outcomes were assessed. The patients were administered systemic intravenous anticoagulation as the initial treatment following admission. SRT-LLT was performed when their condition deteriorated with a high risk of a fatal outcome within a short time period. SRT-LLT was performed in 8 patients, with successful recanalization confirmed by angiography. In 4 of the patients, complete recanalization was achieved, whereas in the remaining 4, recanalization was partial. There were no intraoperative complications. Two patients developed rebleeding after surgery, but they all gradually recovered. There were no treatment-associated fatalities. Therefore, SRT-LLT appears to be a feasible, safe and effective option for SH-CVST and it may be used as rescue therapy for carefully selected patients with SH-CVST.

show abstract

Mechanical Thrombectomy with Intraoperative Local Thrombolysis Versus Mechanical Thrombectomy with Continuous Thrombolysis for Treatment of Cerebral Venous Sinus Thrombosis: A Systematic Review of 82 Cases

Cited by 11 publications

References 41 publications

Factors influencing therapy choice and clinical outcome in cerebral venous sinus thrombosis

Factors influencing therapy choice and clinical outcome in cerebral venous sinus thrombosis

An Update on Diagnosis and Treatment of Cerebral Venous Thrombosis in Adults: A Narrative Review

Stent retriever thrombectomy combined with long‑term local thrombolysis for severe hemorrhagic cerebral venous sinus thrombosis

Contact Info

Product

Resources

About