Novel balloon-and-aspiration method for cerebral venous sinus thrombosis: dental-floss technique

Matsuda, Yoshikazu; Okada, Hideo; Chung, Joonho; Crowley, R. Webster; Lopes, Demetrius K.

doi:10.3171/2017.1.focus16519

Cited by 14 publications

(8 citation statements)

References 14 publications

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“…Both approaches can help loosen and break down the thrombus, increase the contact area between the thrombus and urokinase, and restore the venous outflow channel. Besides being convenient and cheap, angioplasty with a balloon catheter has the advantages of both loosening the thrombus and simultaneously dilating vessels to a normal diameter ( 11 , 19 ). There were no operation-related complications in our case series, which is consistent with the results reported by Shui et al ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…Techniques include direct catheter thrombolysis, balloon-assisted thrombectomy, mechanical thrombectomy, stent retriever thrombectomy, aspiration thrombectomy, or a combination of these. Balloon-assisted thrombectomy has the advantage of both flattening the thrombus and dilating vessels, returning previously structured vessels to their normal diameter ( 11 , 18 , 19 ). However, in the absence of randomized controlled trials, data about balloon-assisted thrombectomy for severe CVST patients remain insufficient.…”

Section: Introductionmentioning

confidence: 99%

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Balloon-Assisted Thrombectomy and Intrasinus Urokinase Thrombolysis for Severe Cerebral Venous Sinus Thrombosis

et al. 2021

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Background: Current clinical guidelines recommend systemic anticoagulation as the initial treatment for severe cerebral venous sinus thrombosis (CVST). However, anticoagulation alone does not always dissolve large and extensive CVSTs in some patients. Here, we investigated the effectiveness and safety of balloon-assisted thrombectomy and intrasinus urokinase thrombolysis in our retrospective study of a series of 23 patients with CVST.Methods: We reviewed the clinical, radiological, and outcome data of all patients. Complete recanalization was defined as all the occluded sinuses were recanalized on digital subtraction angiography or Contrast-enhanced magnetic resonance venography. Partial recanalization was defined as the complete recanalization of one sinus but persistent occlusion of other sinuses, or partial recanalization of one or more sinuses. The modified Rankin Scale (mRS) was used to represent the clinical outcome.Results: From May 2017 to November 2019, a total of 23 patients were treated with balloon-assisted thrombectomy and intrasinus urokinase thrombolysis. A total of 84 venous sinuses were involved, ≥3 sinuses were involved in 20 (87%) patients. Among them, 21 (91%) patients achieved technical success. Complete and partial recanalization were obtained in 17 (81%) and 4 (19%) patients at 6 months follow-up, respectively. All 21 patients had mRS scores of 0 (18) or 1 (3).Conclusions: Our case series shows that balloon-assisted thrombectomy combined with intrasinus urokinase thrombolysis and activated partial thromboplastin time-regulated systemic anticoagulation is safe and effective in treating severe CVST.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Balloon-Assisted Thrombectomy and Intrasinus Urokinase Thrombolysis for Severe Cerebral Venous Sinus Thrombosis

et al. 2021

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“…The AngioJet Thrombectomy system offers catheters for treating vessels of ≥1.5 mm clot burdens. In the current study, clots were larger, and a stent-retriever or a large-bore aspiration system is not a much effective technique when large clots are targeted [ 28 ]. Therefore, the AngioJET system was used to treat ischemic arterial stroke.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Thrombectomy preceded by intravenous Alteplase versus endovascular Thrombectomy alone in Han Chinese patients treated for acute ischemic stroke with large vessel occlusion: a single-center retrospective analysis

Han

Yue

et al. 2021

BMC Neurol

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Background The American Heart Association/ American Stroke Association and the Chinese Stroke Association guidelines are recommending intravenous alteplase intervention before endovascular thrombectomy if patients are eligible to do so but the benefits of endovascular thrombectomy are different in Chinese patients with stroke than those of the white patients. The objective of the study was to compare outcomes of patients with acute ischemic stroke treated with endovascular thrombectomy with intravenous alteplase against those treated with endovascular thrombectomy alone. Methods A report is a retrospective analysis of comparing demographics, imaging, clinical and adverse outcomes in the Han Chinese patient who underwent mechanical thrombectomy for acute ischemic stroke with large vessel occlusion, with or without preceding intravenous alteplase administration. Patients with terminus and non-terminus intracranial occlusions and ≤ 2 points neurologic deficit underwent endovascular thrombectomy preceded by 0.9 mg/ kg intravenous alteplase (ET cohort, n = 184) and those who had contra-indication for intravenous alteplase were treated with endovascular thrombectomy alone (EA cohort, n = 141). Results The most common procedural complications were embolization into new territory (p = 0.866) and uneventful artery vasospasm (p = 0.712). Insignificant differences were reported for any procedural complications (p = 0.991), imaging outcomes, the modified Rankin scale score (p = 0.663), and death (28 vs. 24, p = 0.761) within 90 days between patients of both cohorts. At the discharge of the hospital, the National Institutes of Health Stroke Scale scores of patients of the ET cohort were lower than those of the EA cohort (8.58 ± 3.79 vs. 10.23 ± 4.97, p = 0.003). The Barthel Index of survivors at 90 days after endovascular thrombectomy was higher for patients of the ET cohort than those of the EA cohort (87.47 ± 12.58 vs. 84.01 ± 13.47, p = 0.032). The most common adverse effect was asymptomatic intracranial hemorrhage (p = 0.297). Insignificant differences were reported for adverse effects after thrombectomy between survivors of both cohorts. Conclusions Outcome measures in Han Chinese patients with acute ischemic stroke treated with endovascular thrombectomy alone were statistically the same as those treated with endovascular thrombectomy plus intravenous alteplase. Level of evidence Iii Technical efficacy stage 4.

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“…This includes direct aspiration thrombectomy, stent retriever thrombectomy, balloon thrombectomy, balloon angioplasty and stenting, AngioJet. However; it is unclear which approach and or devices provides the optimal restoration of venous blood flow; and further evidence is needed (8)(9)(10).…”

Section: Discussionmentioning

confidence: 99%

First off Label Endovascular Clinical Experience to Treat Diffuse Cerebral Venous Sinus Thrombosis Using the INARI FlowTriever System: Case Report

et al. 2021

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Anticoagulation with heparin is the current mainstay treatment for Cerebral Venous Sinus Thrombosis (CVST). Endovascular treatment is increasingly being used to treat patients with CVST who are non-responsive to anticoagulation. These more aggressive interventions include catheter-based local chemical thrombolysis, balloon angioplasty and mechanical thrombectomy with uncertain safety and efficacy. Here we describe the first reported clinical experience using the INARI FlowTriever system to treat a patient presented with focal weakness and found to have diffuse CVST.

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Novel balloon-and-aspiration method for cerebral venous sinus thrombosis: dental-floss technique

Cited by 14 publications

References 14 publications

Balloon-Assisted Thrombectomy and Intrasinus Urokinase Thrombolysis for Severe Cerebral Venous Sinus Thrombosis

Balloon-Assisted Thrombectomy and Intrasinus Urokinase Thrombolysis for Severe Cerebral Venous Sinus Thrombosis

Endovascular Thrombectomy preceded by intravenous Alteplase versus endovascular Thrombectomy alone in Han Chinese patients treated for acute ischemic stroke with large vessel occlusion: a single-center retrospective analysis

First off Label Endovascular Clinical Experience to Treat Diffuse Cerebral Venous Sinus Thrombosis Using the INARI FlowTriever System: Case Report

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