Stent retriever thrombectomy combined with local thrombolytic therapy for cerebral venous sinus thrombosis: A case report

Abstract

The present study reports the effect of successful treatment of cerebral venous sinus thrombosis (CVST) with stent retriever thrombectomy combined with local thrombolytic therapy. Medical records of 29 patients were retrospectively analyzed following a diagnosis of CVST with magnetic resonance venography (MRV) or digital subtraction angiography (DSA). Systemic anticoagulation was the initial treatment in all patients following admission. In group A, stent retriever thrombectomy combined with local thrombolytic therapy was performed on 14 patients who met the criteria of endovascular therapy. Stent-assisted angioplasty was also performed when patients presented with venous sinus stenosis. A total of 15 patients in group B received systemic anticoagulant treatment. Subsequently, warfarin was administered orally for 3 to 12 months as a continuous anticoagulant therapy. International normalized ratio was monitored when patients were receiving anticoagulant therapy. Additionally, clinical presentation, decision to escalate therapy, recanalization, Glasgow Coma Scale, modified Rankin Scale (mRS) and the clinical outcome was assessed. A total of 14 patients (9 female patients, 5 male patients), with ages ranging from 17 to 57 years, met the criteria of endovascular therapy. The clinical symptoms of 12 patients had improved after receiving endovascular therapy and only 2 patients suffered from intracranial hemorrhage following the procedure. Complete recanalization of venous sinus was exhibited in 10/14 (71.4%) patients in group A when compared with 1/15 (6.7%) patients in group B. mRS were improved in the 12-month follow-up in groups A and B when compared with that at admission. In the present study, patients with acute CVST treated with stent retriever thrombectomy combined with local thrombolytic therapy had a favorable outcome. To conclude, the present study provides a treatment option in treating CVST, particularly for patients that present with evident cortical venous outflow stasis or deteriorate neurology, despite appropriate anticoagulant therapy.

Safety and efficacy of endovascular thrombectomy in patients with severe cerebral venous thrombosis: A meta-analysis

“…Of the 33 studies, 26 were in the English language and 7 were exclusively in the Chinese language. 14-20 Seventeen studies were conducted in China, 9,11-29 5 in the USA 30-34 , 2 in Taiwan 12,35 and India, 36,37 two were multicenter studies (one conducted in USA and Netherlands 38 and other in the Netherlands, China, and Portugal 9 ), one study each was conducted in the UK 39 , Hong Kong, 40 Netherlands, 13 Denmark 41 and Germany. 42

Figure 1.PRISMA flow diagram depicting the flow of information through the different phases of a systematic review.

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“…Of the 33 studies, 26 were in the English language and 7 were exclusively in the Chinese language. [14][15][16][17][18][19][20] Seventeen studies were conducted in China, 9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] 5 in the USA [30][31][32][33][34] , 2 in Taiwan 12,35 and India, 36,37 two were multicenter studies (one conducted in USA and Netherlands 38 and other in…”

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

“…The heparin was given via intravenous injection according to the activated clotting time (ACT) if the patient had already received heparin injection at another hospital or if there was a low risk of rebleeding. SRT-LLT was performed on patients when presenting with the following: i) Failure of first-line anticoagulation; ii) rapid deterioration of consciousness or neurological impairment; and iii) significant cortical venous outflow stasis (arterio-venous circulation time >11 sec; venous phase >5 sec) (14). In the present study, 8 patients received endovascular SRT-LLT therapy.…”

Endovascular Interventional Management of Cerebral Venous Sinus Thrombosis

“…In a retrospective study by Chen and colleagues, 19 29 patients with CVST were studied. A total 14 patients under-went endovascular therapy, of whom 12 improved and 2 developed intracranial hemorrhage.…”

“…The primary outcome at 3 to 6 month follow-up, however revealed a good outcome of mRS < 1 in 224 patients. 18 In a retrospective study by Chen and colleagues, 19 29 patients with CVST were studied. A total 14 patients underwent endovascular therapy, of whom 12 improved and 2 developed intracranial hemorrhage.…”