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Nguyen VN, Demetriou AN, Dallas J, Mack WJ. Cerebral Venous Sinus Thrombosis. Neurosurg Clin N Am 2024; 35:343-353. [PMID: 38782527 DOI: 10.1016/j.nec.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare type of stroke indicated by the formation of blood clots within the dural venous sinuses. These are large venous conduits that are situated between the 2 layers of the dura mater which are responsible for draining blood from the brain and returning it to the systemic circulation. Cortical venous thrombosis refers to the blockage of veins on the brain's cortical surface. Cerebral venous thrombosis encompasses both dural and cortical vein occlusions.
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Affiliation(s)
- Vincent N Nguyen
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA
| | - Alexandra N Demetriou
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA
| | - Jonathan Dallas
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA
| | - William J Mack
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA.
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2
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Batista S, Sanches JPB, Andreão FF, Porto Sousa M, Oliveira LDB, Yuri Ferreira M, Bertani R, Alves Filho CAF, de Oliveira Braga F, Machado EAT, da Mata Pereira PJ, Niemeyer Filho P, Almeida Filho JA. Evaluating the efficacy of stent retriever and catheter aspiration combination in refractory cerebral venous sinus Thrombosis: A comprehensive Meta-Analysis. J Clin Neurosci 2024; 120:154-162. [PMID: 38244530 DOI: 10.1016/j.jocn.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Cerebral Venous Sinus Thrombosis (CVST) is a rare but potentially life-threatening condition, often associated with specific risk factors. The primary treatment for CVST is anticoagulation, but some cases progress to Refractory CVST (rCVST), requiring endovascular treatment. A combination of stent retriever and catheter aspiration is emerging as a promising technique to enhance treatment effectiveness. We conducted a systematic review and meta-analysis to assess the safety and efficacy of this approach, aiming to improve recanalization success and neurological outcomes while reducing complications in rCVST patients. METHODS A search following PRISMA guidelines was conducted across Pubmed, Embase, Web of Science, and Cochrane databases to identify studies on the use of stent retrievers and catheter aspiration for rCVST. Pooled analysis with 95 % confidence intervals was used to assess the effects. Heterogeneity was evaluated using I2 statistics and a random-effects model was used. Complete recanalization. good clinical outcomes (mRS ≤ 2), hemorrhagic, neurological, ischemic, and total complications, poor clinical outcomes (mRS > 2), and mortality were assessed. RESULTS A meta-analysis of five retrospective studies involving 55 patients examined outcomes in CVST. The median mean age was 40 years. Complete recanalization rate: 36 % (95 % CI: 9 % to 62 %, I2 = 90 %). Good clinical outcomes: 72 % (95 % CI: 50 % to 94 %, I2 = 76 %). Hemorrhagic complications: 2 % (95 % CI: 0 % to 8 %, I2 = 15 %). Ischemic complications: 0 % (95 % CI: 0 % to 6 %, I2 = 0 %). Neurological complications: 7 % (95 % CI: 0 % to 14 %, I2 = 0 %). Poor clinical outcomes: 26 % (95 % CI: 6 % to 46 %, I2 = 70 %). Total complications: 6 % (95 % CI: 0 % to 15 %, I2 = 10 %). Mortality rate: 5 % (95 % CI: 0 % to 13 %, I2 = 19 %). CONCLUSION This systematic review and meta-analysis scrutinized the efficacy of combining Stent Retriever and Catheter Aspiration for rCVST. Findings highlighted varied outcomes, including recanalization rates, complications, and mortality. The dichotomy between good and poor outcomes underscores the necessity for personalized therapeutic decisions. While offering a comprehensive overview, the study emphasizes literature heterogeneity, suggesting a need for more rigorous and standardized research to optimize therapeutic strategies in clinical practice.
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Affiliation(s)
- Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Filipi Fim Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Faculty of Medicine, State University of Ponta Grossa, Ponta Grossa, PR, Brazil; Faculty of Medicine, Ninth July University - São Paulo, SP, Brazil; Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil; Department of Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, RJ, Brazil
| | - Marcelo Porto Sousa
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Paulo Niemeyer Filho
- Department of Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, RJ, Brazil
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Dhok SM, Gudipati AR, Kaul S, Yada P, Babu PS. Combined Use of Copernic RC Venous Remodeling Balloon and Aspiration Thrombectomy for Cerebral Venous Sinus Thrombosis. Neurol India 2023; 71:1235-1238. [PMID: 38174464 DOI: 10.4103/0028-3886.391391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Cerebral venous sinus thrombosis is a potentially fatal condition. The current first line of treatment for sinus thrombosis is anticoagulation. Endovascular treatment is an alternative for patients whose symptoms progress despite adequate medical management. Mechanical thrombectomy is required in the setting of a large clot burden. Unfortunately, the conventional technique of intraarterial thrombectomy with the use of a stent retriever and/or aspiration is not very effective in sinus thrombosis because of a larger clot burden compared to an intracranial artery. Herein we describe our endovascular approach of mechanical thrombectomy in sinus thrombosis using Copernic 8 × 80 RC (Rene Chapot) balloon and aspiration catheter.
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Affiliation(s)
- Swapnil M Dhok
- Assistant Professor in Radiodiagnosis, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Ananta R Gudipati
- Neurointerventional Radiology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Subhash Kaul
- Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Praveen Yada
- Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - P Suresh Babu
- Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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Tang SZ, Jing M, Yang C, Yeo LLL, Tan BYQ, Chan BPL, Vijay KS, Teoh HL, Anil G. Safety and clinical outcomes in endovascular treatment for symptomatic cerebral venous thrombosis: a single-center experience with meta-analysis. Neurosurg Rev 2023; 46:114. [PMID: 37160781 DOI: 10.1007/s10143-023-02012-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/05/2023] [Accepted: 04/23/2023] [Indexed: 05/11/2023]
Abstract
The role of mechanical thrombectomy (MT) in cerebral venous sinus thrombosis (CVT) is ambiguous. This study aims to share our experience with MT in CVT, supplemented by a meta-analysis on this treatment. All patients who had MT for CVT at our institution, between 2016 and 2021, were retrospectively reviewed for treatment indications, the technique used, success and complication rates, and clinical outcomes. A meta-analysis was performed for clinical and safety outcomes from published literature with > 10 patients. A total of 15 patients were included in this study. All had a venous hemorrhage or deteriorating despite anticoagulation. MT was performed using aspiration (with wide bore catheters) in 7 patients: aspiration with stent retriever in 5 and transjugular Fogarty-balloon thrombectomy in 3 patients. Adjunctive intra-sinus thrombolysis (IST) was used in 4 cases and venoplasty in 3. Technical success (restoring antegrade venous flow on arterial injection) was 100% with no procedure-related major complication. The direct transjugular approach was cheaper and faster. At 3-month follow-up, 86% of patients had good outcomes (MRS < 2). Meta-analysis of clinical and safety outcomes from 22 and 20 studies, respectively, demonstrated a positive association between MT and good outcomes as well as no significant association with hazardous periprocedural events. EVT via mechanical means for CVT is feasible in our series and meta-analysis. From our experience, trans-jugular Fogarty balloon embolectomy seems to be a potential cost-saving option, at least in a certain part of the world.
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Affiliation(s)
- Si Zhao Tang
- Division of Interventional Radiology, Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore.
| | - Mingxue Jing
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Cunli Yang
- Division of Interventional Radiology, Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Leonard Litt Leong Yeo
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Bernard Poon Lap Chan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Kumar Sharma Vijay
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Hock-Luen Teoh
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Gopinathan Anil
- Division of Interventional Radiology, Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
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5
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Jedi F, Dethlefs G, Hauser TK, Hennersdorf F, Mengel A, Ernemann U, Bender B. Mechanical Thrombectomy in Cerebral Venous Sinus Thrombosis: Reports of a Retrospective Single-Center Study. J Clin Med 2022; 11:6381. [PMID: 36362608 PMCID: PMC9655339 DOI: 10.3390/jcm11216381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/18/2022] [Accepted: 10/27/2022] [Indexed: 10/24/2023] Open
Abstract
Current standard care for acute cerebral venous sinus thrombosis (CVST) includes either intravenous heparin or subcutaneous low-molecular-weight heparin, but patients with refractory CVST, despite adequate anticoagulation therapy, may benefit from mechanical thrombectomy (MT). A retrospective study of patients with CVST, who underwent MT between 2011 and 2019, was performed looking at procedure success rate and clinical outcomes. Two raters evaluated the cerebral venous system of every patient before and after the intervention using the following scoring system: (0) No obvious thrombosis; (1) thrombosis without impaired blood flow; (2) thrombosis with impaired blood flow; (3) and thrombosis with complete vascular occlusion. The success of MT was measured using a score quotient (Q = A/B), dividing the sum of the patient's scores after the intervention (A) by the sum of scores before the intervention (B). Overall, 21 MTs were performed on 20 patients with refractory or severe CVST. Clinical improvement was seen in 61.9% during hospital stay and in 80% at 6-month follow-up, with complete recovery in 70% of patients. Patients with favorable outcomes had significantly lower recanalization quotients (p = 0.008). Our study provides evidence supporting that MT may be a safe and effective treatment with favorable clinical outcomes for selected patients with CVST.
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Affiliation(s)
- Farzaneh Jedi
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Gero Dethlefs
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Till-Karsten Hauser
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Florian Hennersdorf
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Annerose Mengel
- Department of Neurology and Stroke, Hertie-Institute for Clinical Brain Research, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, 72076 Tübingen, Germany
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Nepal G, Kharel S, Bhagat R, Coghlan MA, Yadav JK, Goeschl S, Lamichhane R, Phuyal S, Ojha R, Shrestha GS. Safety and efficacy of endovascular thrombectomy in patients with severe cerebral venous thrombosis: A meta-analysis. J Cent Nerv Syst Dis 2022; 14:11795735221131736. [PMID: 36204279 PMCID: PMC9530583 DOI: 10.1177/11795735221131736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background Cerebral venous thrombosis (CVT) is a rare thrombotic condition which is traditionally
treated with anti-coagulation therapy. Subsets of patients with severe CVT have been
treated with endovascular thrombectomy (EVT). Despite the high estimated mortality
associated with severe CVT, there has been only one randomized control trial done
regarding safety and efficacy of EVT in severe CVT compared to standard medical
management. Evidence in this area is lacking. Objective The aim of this systematic review is to analyze all existing literature and generate
robust information regarding the role of EVT in the management of patients with severe
CVT. Methods This systematic review and meta-analysis followed PRISMA guideline. PubMed, Embase,
Google Scholar, and CNKI were searched for eligible studies from 2007 to 2021. Safety
and efficacy of EVT were evaluated by meta-analyzing recanalization status, the good
functional outcome at follow-up, recurrent CVT, new hematoma. A pooled proportion with a
95% confidence interval was derived from a meta-analysis of various outcomes (CI). Results A total of 33 studies comprising 610 patients treated with EVT were included for
analysis which comprised one randomized control trial, one prospective study and 31
retrospective studies. Based on pooled data, 85% of patients had good functional
outcome, 62% had complete recanalization, 5% had all-cause mortality, and 3% had
catheter related complications. The efficacy outcomes in this analysis had a significant
heterogeneity and a subgroup analysis was also done to explain these findings. The
minimum time of follow up was 3 months and varied EVT techniques were used across the
studies. Conclusion This meta-analysis suggests EVT may be safe and efficacious in treating patients with
severe CVT. Registration Our protocol was registered with PROSPERO: International prospective register of
systematic reviews with the registration number CRD42021254760.
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Affiliation(s)
- Gaurav Nepal
- Department of Internal Medicine,
Maharajgunj Medical Campus, Tribhuvan University Institute of
Medicine, Maharajgunj, Nepal
| | - Sanjeev Kharel
- Department of Internal Medicine,
Maharajgunj Medical Campus, Tribhuvan University Institute of
Medicine, Maharajgunj, Nepal
| | - Riwaj Bhagat
- Department of Neurology, Boston University Medical Center, Boston, MA, USA
| | - Megan A Coghlan
- Department of Neurology, University of Louisville School of
Medicine, Louisville, KY, USA
| | - Jayant K Yadav
- Department of Internal Medicine,
Maharajgunj Medical Campus, Tribhuvan University Institute of
Medicine, Maharajgunj, Nepal
| | - Stella Goeschl
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Rajan Lamichhane
- Department of Internal Medicine,
Maharajgunj Medical Campus, Tribhuvan University Institute of
Medicine, Maharajgunj, Nepal
| | - Subash Phuyal
- Department of Neuroimaging and
Interventional Neuroradiology, Upendra Devkota Memorial National Institute of
Neurological and Allied Sciences, Bansbari, Nepal
| | - Rajeev Ojha
- Department of Neurology, Tribhuvan University Teaching
Hospital, Maharajgunj, Nepal
| | - Gentle S Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching
Hospital, Maharajgunj, Nepal,Gentle S Shrestha, Department of Critical Care
Medicine, Tribhuvan University Teaching Hospital, Maharajgunj 44600, Kathmandu, Nepal.
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Endovascular Treatment of Intracranial Vein and Venous Sinus Thrombosis—A Systematic Review. J Clin Med 2022; 11:jcm11144215. [PMID: 35887982 PMCID: PMC9319519 DOI: 10.3390/jcm11144215] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Cerebral venous sinus or vein thromboses (SVT) are treated with heparin followed by oral anticoagulation. Even after receiving the best medical treatment, numerous patients experience neurological deterioration, intracerebral hemorrhage or brain edema. Debate regarding whether endovascular treatment (EVT) is beneficial in such severe cases remains ongoing. This systematic review summarizes the current evidence supporting the use of EVT for SVT on the basis of case presentations, with a focus on patient selection, treatment strategies and the effects of the COVID-19 pandemic. Methods: This systemic literature review included randomized controlled trials (RCTs) and retrospective observational data analyzing five or more patients. Follow-up information (modified Rankin scale (mRS)) was required to be provided (individual patient data). Results: 21 records (n = 405 patients; 1 RCT, 20 observational studies) were identified. EVT was found to be feasible and safe in a highly selected patient cohort but was not associated with an increase in good functional outcomes (mRS 0–2) in RCT data. In observational data, good functional outcomes were frequently observed despite an anticipated poor prognosis. Conclusion: The current evidence does not support the routine incorporation of EVT in SVT treatment. However, in a patient cohort prone to poor prognosis, EVT might be a reasonable therapeutic option. Further studies determining the patients at risk, choice of methods and devices, and timing of treatment initiation are warranted.
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Mera Romo WC, Ariza-Varón M, Escobar FN, Castillo AL. Cerebral venous sinus thrombosis treated with vacuum aspiration thrombectomy without thrombolysis: A descriptive and retrospective study of 5 years' experience at a single center. J Vasc Interv Radiol 2022; 33:1173-1183.e1. [PMID: 35835358 DOI: 10.1016/j.jvir.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 06/11/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Cerebral venous sinus thrombosis (CVST) is a rare but life-threatening condition. Mechanical thrombectomy is a treatment option for patients who deteriorate or do not improve despite anticoagulation treatment or who have a major contraindication to anticoagulation. The purpose of this study was to describe our 5 years of experience in treating CVST with vacuum aspiration thrombectomy without thrombolysis. MATERIALS AND METHODS For this retrospective study, data were collected from consecutive patients with CVST who received anticoagulation as initial medical treatment and then were treated with vacuum aspiration thrombectomy without thrombolysis. Patients were followed up at 3 months and after 1 year. RESULTS The 9 patients included in the study had a median age of 37 years, and 5 were female. All 9 patients had headache at presentation; 7 had focal neurologic deficits and 7 had intracranial hypertension. Risk factors for CVST were identified in 8 patients, and poor prognostic factors were identified in 7 patients. In the 9 patients, a total of 24 CVST locations were treated; complete (70.8%) or partial (29.2%) recanalization was achieved in all CVST locations. No procedure-related complications occurred. One patient died of parenchymal hemorrhagic transformation of CVST and vasogenic edema, at 6 hours after the procedure. Two patients required neurosurgical intervention. After 1 year (range, 13-30 months), all 8 surviving patients had good functional outcome (modified Rankin Scale score 0-2). CONCLUSIONS For appropriately selected patients with cerebral venous sinus thrombosis, vacuum aspiration thrombectomy without thrombolysis appears to be an effective therapy.
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Affiliation(s)
- Walter Camilo Mera Romo
- Department of Diagnostic Imaging, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, Colombia; Radiology Resident of Department of Diagnostic Imaging, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, Colombia.
| | - Michael Ariza-Varón
- Department of Clinical Neurology, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, Colombia; Research Group NeuroUnal, Department of Clinical Neurology, Universidad Nacional de Colombia, Bogotá, Colombia; Clinical Neurology Resident, Department Clinical Neurology of Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, D.C. Colombia
| | - Fabian Neira Escobar
- Department of Diagnostic Imaging, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, Colombia; Radiology Specialist, Universidad Nacional de Colombia, Bogotá, Colombia; Subspecialty in Oncological Radiology, Pontificia Universidad Javeriana, Interventional Radiologist, Hospital Universitario Nacional, Bogotá, D.C. Colombia; Subspecialty in Endovascular Neurointerventionism, Hospital General de Catalunya, Cataluña, Spain
| | - Alfonso Lozano Castillo
- Department of Diagnostic Imaging, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, Colombia; Radiology Specialist, Universidad Nacional de Colombia, Bogotá, Colombia
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Goyal JL, Singh S, Mishra SC, Singh S, Singh D. Management of neurovascular emergencies with ophthalmic manifestations. Oman J Ophthalmol 2022; 15:133-139. [PMID: 35937751 PMCID: PMC9351942 DOI: 10.4103/ojo.ojo_215_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/07/2021] [Accepted: 03/24/2022] [Indexed: 11/17/2022] Open
Abstract
Patients with neurovascular disorders sometimes approach the ophthalmologists with mild ophthalmic clinical features such as conjunctival congestion, slowly progressive proptosis, lateral rectus palsies and at other times with ophthalmic emergencies like sudden increase in proptosis, ophthalmoplegia, diplopia, and ptosis before the onset of neurological manifestations which may be life-threatening if not detected in time. The aim of this article is to focus on ophthalmic manifestations of neurovascular emergencies and role of ophthalmologists in its management. In this communication, to make the ophthalmologist aware of clinical presentations, the imaging modality of choice, diagnostic features, medical and interventional treatments. We have searched PubMed, Web of Science, Google Scholar and reviewed some of the commonly encountered neurovascular emergencies with ocular manifestations such as carotid-cavernous fistula, cerebral venous sinus thrombosis, cerebral artery aneurysms, arterio-venous malformations.
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Affiliation(s)
- Jawahar Lal Goyal
- Department of Ophthalmology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India,Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shalini Singh
- Department of Ophthalmology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India,Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India,Address for correspondence: Dr. Shalini Singh, 110, New Colony, Krishna Bihari Nagar, Fatehpur, Uttar Pradesh, India. E-mail:
| | - Sarvesh Chandra Mishra
- Department of Ophthalmology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India,Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shipra Singh
- Department of Ophthalmology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India,Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Divya Singh
- Department of Ophthalmology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India,Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Wang C, Sun J, Shao J, Zhang X, Chen X. Clinical Observation and Value Analysis of Endovascular Interventional Therapy for Intracranial Venous Sinus Thrombosis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4931210. [PMID: 35747500 PMCID: PMC9213190 DOI: 10.1155/2022/4931210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/29/2022] [Accepted: 05/07/2022] [Indexed: 11/17/2022]
Abstract
The main aim of this study was to investigate the therapeutic effect of endovascular interventional therapy on cerebral venous sinus thrombosis (CVST). 137 patients with CVST were included, 92 patients were treated with interventional therapy, and 45 patients were treated with conventional anticoagulant therapy. Through endovascular therapy (EVT) combined with therapy, the patients were treated with EVT in combination with conventional anticoagulant therapy, and the prognosis of the two groups of patients was evaluated. The results showed that 26 patients were complicated with female-specific infections in the combined EVT group, and 7 patients had female-specific infections in the simple anticoagulant therapy (LMWH) group. In terms of central nervous system infections, the EVT group was significantly lower than the LMWH group, P < 0.001, and the difference was statistically significant. There were 2 cases of EVT involving the inferior sagittal sinus and 12 cases of LMWH involving the inferior sagittal sinus, P < 0.001, and the difference had statistical significance. Through the RANKIN scale (mRS) score, it was classified as complete recovery and good prognosis (dependent variable). The patients receiving EVT with good prognosis (96.7%) were more than those receiving simple anticoagulant therapy (84.4%), and 78.3% were completely recovered after EVT, and 77.5% were completely recovered after anticoagulant therapy. Therefore, it can be concluded that gender, malignant tumors, thrombosis, and sinuses are all risk factors affecting the prognosis of patients; both endovascular interventional therapy and anticoagulant therapy can significantly improve the prognosis of patients.
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Affiliation(s)
- Cheng Wang
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Jun Sun
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Junfei Shao
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xiaolu Zhang
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xiang Chen
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
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Higaki R, Yamaguchi S, Haruyama H, Osaki M, Arakawa S, Sayama T. Effectiveness of the Digging through Thrombus Technique by Using an Aspiration Catheter and Stent Retriever for Cerebral Venous Thrombosis. Neurol Med Chir (Tokyo) 2022; 62:336-341. [PMID: 35613878 PMCID: PMC9357457 DOI: 10.2176/jns-nmc.2021-0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare cause of stroke, and the first-line treatment is systemic anticoagulation. Patients unresponsive to standard therapy for CVT present with rapid neurological deterioration and require endovascular treatment. We encountered two patients with severe CVT who underwent endovascular treatment. In our cases, the thrombus was too hard and extensive to pass through using currently existing techniques. We performed the "digging through thrombus technique" using an aspiration catheter and stent retriever and achieved rapid sinus recanalization and favorable outcomes.
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Affiliation(s)
- Rio Higaki
- Department of Neurosurgery, Steel Memorial Yawata Hospital
| | | | | | - Masato Osaki
- Department of Cerebrovascular Disease, Steel Memorial Yawata Hospital
| | - Shuji Arakawa
- Department of Cerebrovascular Disease, Steel Memorial Yawata Hospital
| | - Tetsuro Sayama
- Department of Neurosurgery, Steel Memorial Yawata Hospital
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Zhou B, Huang SS, Huang C, Liu SY. Cerebral venous sinus thrombosis in pregnancy: A case report. World J Clin Cases 2022; 10:309-315. [PMID: 35071533 PMCID: PMC8727275 DOI: 10.12998/wjcc.v10.i1.309] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/09/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cerebral venous thrombosis (CVT) is a rare but life-threatening disease in pregnant women. Anticoagulation is the first-line therapy for CVT management. However, some patients have poor outcomes despite anticoagulation. Currently, the endovascular treatment of CVT in pregnant women remains controversial. We report a rare case of CVT in a pregnant woman who was successfully treated with two stent retriever devices.
CASE SUMMARY The patient was a 29-year-old pregnant woman. She was first diagnosed with hyperemesis gravidarum due to severe nausea and vomiting for one week. As the disease progressed, she developed acute left hemiplegia. Imaging confirmed the diagnosis of superior sagittal sinus, right transverse sinus and sinus sigmoideus thrombosis. As anticoagulant therapy was ineffective, she underwent thrombectomy. After the mechanical thrombectomy, her headache diminished. Three weeks later, the patient was completely independent. At a 3-mo follow-up, no relapse of symptoms was observed.
CONCLUSION Mechanical thrombectomy may be an effective alternative therapy for CVT in pregnant women if anticoagulation therapy fails.
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Affiliation(s)
- Biao Zhou
- Department of Neurology, Dongguan Tungwah Hospital, Dongguan 523000, Guangdong Province, China
| | - Shan-Shan Huang
- Department of Intensive Care Unit, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen 518000, Guangdong Province, China
| | - Can Huang
- Department of Neurology, Dongguan Tungwah Hospital, Dongguan 523000, Guangdong Province, China
| | - Shu-Yun Liu
- Department of Neurology, Shenzhen Longhua District Central Hospital, Shenzhen 518000, Guangdong Province, China
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The clinical analysis and treatment strategy of endovascular treatment for cerebral venous sinus thrombosis combined with intracerebral hemorrhage. Sci Rep 2020; 10:22300. [PMID: 33339854 PMCID: PMC7749176 DOI: 10.1038/s41598-020-78570-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/18/2020] [Indexed: 11/16/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) combined with intracerebral hemorrhage(ICH) is a special subgroup, and whether intrasinus thrombolysis (IST) or mechanical thrombectomy (MT) therapy should be carried out is controversial because of previous hemorrhage and possible delayed hemorrhage.The aim of this study was to analyze the safety and effectiveness of endovascular treatment of CVST with ICH and further discuss the treatment strategy. This is a retrospective study of 56 cases admitted from January 2010 to June 2019 diagnosed with CVST combined with ICH, and all were treated with endovascular treatment including IST with or without MT. We reviewed the clinical, radiological, and outcome data of all patients. The percentage of cases that showed complete and partial recanalization were 67.8% and 26.9% after endovascular treatment. ICH exacerbation occurred in 5 cases during thrombolysis. The percentage of cases with good outcome was 87.5% at discharge. 51 cases were followed up at sixth month. 49 cases had a mRS score of 0–2,and 2 cases had a mRS score of 3–4 at sixth month.Our data suggest that endovascular treatment may improve clinical and radiological outcome in most patients of CVST with ICH, but confirmation in prospective, controlled studies is warranted.
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Wang Y, Zhao C, Huang D, Sun B, Wang Z. Stent retriever thrombectomy combined with long-term local thrombolysis for severe hemorrhagic cerebral venous sinus thrombosis. Exp Ther Med 2020; 20:66. [PMID: 32963596 PMCID: PMC7490800 DOI: 10.3892/etm.2020.9194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/10/2020] [Indexed: 01/21/2023] Open
Abstract
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.
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Affiliation(s)
- Yihua Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Qingdao, Shandong 266035, P.R. China
| | - Cuiping Zhao
- Department of Neurology, Qilu Hospital of Shandong University, Qingdao, Shandong 266035, P.R. China
| | - Dezhang Huang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Qingdao, Shandong 266035, P.R. China
| | - Bin Sun
- Department of Neurosurgery, Qilu Hospital of Shandong University, Qingdao, Shandong 266035, P.R. China
| | - Zhigang Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Qingdao, Shandong 266035, P.R. China
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Mechanical Thrombectomy for Cerebral Venous Sinus Thrombosis: A Case Series and Technical Note. World Neurosurg 2020; 140:148-161. [PMID: 32389866 DOI: 10.1016/j.wneu.2020.04.220] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cerebral venous sinus thrombosis is a rare cause of acute stroke. It may lead to hemorrhagic venous infarctions, brain swelling, or raised intracranial pressure and can be associated with significant mortality and morbidity. Low-molecular-weight heparin is the mainstay of treatment. Endovascular treatment is reserved for patients who deteriorate despite medical management. METHODS Retrospective evaluation of our institutional databases from 2018-2019 revealed 7 patients who underwent aspiration thrombectomy using large-bore aspiration catheters for recanalization of the dural sinuses with or without intrasinus thrombolysis during the procedure. Their clinical, imaging findings, endovascular technique, and outcome are discussed. RESULTS We treated 7 patients who did not respond to best medical management. Aspiration thrombectomy was the primary mode of endovascular treatment. Adjuvant low-dose (10 mg recombinant tissue plasminogen activator), short-duration (20-minute) intrasinus thrombolysis was used in 4 patients only during the procedure. Headache was the most common symptom, followed by seizures, focal neurologic deficits, and vomiting. There was improvement in clinical condition within 24 hours of procedure in all patients. The 30-day modified Rankin Scale score was 0 in 6 patients. One patient had residual hemiparesis and aphasia. There were no procedure-related complications. CONCLUSIONS The described technique appears to be simple, safe, and effective and results in a relatively short procedure time in achieving complete or partial recanalization of the dural sinuses in patients who deteriorate despite clinical management. Endovascular thrombectomy along with conventional medical management restores the final drainage pathway of the brain with good clinical outcome.
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Endovascular Mechanical Thrombectomy and On-Site Chemical Thrombolysis for Severe Cerebral Venous Sinus Thrombosis. Sci Rep 2020; 10:4937. [PMID: 32188921 PMCID: PMC7080812 DOI: 10.1038/s41598-020-61884-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/28/2020] [Indexed: 11/29/2022] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare cause of cerebral infarction. Once patients survive the acute phase, long-term prognosis is generally satisfactory. CVST patients who harbored risk factors known for poor prognosis (e.g., deterioration of consciousness/neurological functions and seizures) were oftentimes unresponsive to systemic heparin treatment. The advantage of combined endovascular mechanical thrombectomy (EMT) and on-site chemical thrombolysis (OCT) plus systemic heparin for CVST over the heparin treatment alone has not been proved. A retrospective study was conducted to analyze consecutive patients with CVST from 2005 to 2015. Patients having clinical improvement or stable disease after heparin treatment were in I/S group; patients having continuous deterioration of consciousness/neurological functions and refractory seizures (despite the use of multiple anti-epileptic drugs) after heparin treatment were in D group. EMT and OCT were indicated for patients in D group. Imaging studies and medical records were reviewed for statistical analysis. Safety issues included new-onset/progression of symptomatic intracerebral hemorrhages (ICH) or procedure-related complications. Total thirty patients were included (I/S group = 16; D group = 14). In D group, the mean time frame from the start of heparin treatment to the endovascular treatment was 3.2 days. Compared with I/S group, all patients in D group had complete stenosis of the sinuses, with higher initial mRS, lower initial GCS, and more seizures (p = 0.006, 0.007, and 0.031, respectively), but no significant differences in the mRS at discharge (p = 0.504). Shorter length of thrombosis and lower initial mRS were associated with better outcomes (p = 0.009 and 0.003, respectively). Thrombosis involving the superior sagittal sinus (SSS) was associated with bad outcomes (p = 0.026). There were two patients (6.7%) with worsening symptomatic ICH, one in each group, managed surgically. The overall mortality of the study was 6.7% (2/30). Combined EMT and OCT after heparin treatment for severe CVST were reasonably safe, which might be considered as a salvage treatment in severe CVST patients who are unresponsive to heparin with heavy clot burden involving SSS in the acute phase. However, further studies are needed to confirm its efficacy and validity.
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Lewis W, Saber H, Sadeghi M, Rajah G, Narayanan S. Transvenous Endovascular Recanalization for Cerebral Venous Thrombosis: A Systematic Review and Meta-Analysis. World Neurosurg 2019; 130:341-350. [DOI: 10.1016/j.wneu.2019.06.211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 01/07/2023]
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18
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Omoto K, Nakagawa I, Park HS, Wada T, Motoyama Y, Kichikawa K, Nakase H. Successful Emergent Endovascular Mechanical Thrombectomy for Pediatric and Young Adult Cerebral Venous Sinus Thrombosis in Coma. World Neurosurg 2019; 122:203-208. [DOI: 10.1016/j.wneu.2018.10.189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/23/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
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Lal D, Gujjar AR, Ramachandiran N, Obaidi A, Kumar S, El-Tigani M, Al-Azri F, Al-Asmi AR. Spectrum of Cerebral Venous Thrombosis in Oman. Sultan Qaboos Univ Med J 2018; 18:e329-e337. [PMID: 30607274 DOI: 10.18295/squmj.2018.18.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/07/2018] [Accepted: 04/12/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives Cerebral venous thrombosis (CVT) can have varied and life-threatening manifestations. This study aimed to examine the spectrum of its clinical presentations and outcomes in a tertiary hospital in Oman. Methods This retrospective study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2009 and December 2017. The medical records of all patients with CVT were reviewed to determine demographic characteristics, clinical features and patient outcomes. Results A total of 30 patients had CVT. The mean age was 36.8 ± 11 years and the male-to-female ratio was 2:3. Common manifestations included headache (83%), altered sensorium (50%), seizures (43%) and hemiparesis (33%). Underlying risk factors were present in 16 patients (53%). Computed tomography or magnetic resonance imaging of the brain was abnormal in all patients, with indications of infarcts (40%) and major sinus thrombosis (100%). There were five cases (20%) of deep CVT. The patients were treated with low-molecular-weight heparin, mannitol and anticonvulsants. The majority (77%) had no residual neurological deficits at follow-up. Conclusion These findings indicate that CVT is a relatively uncommon yet treatable disorder in Oman. A high index of suspicion, early diagnosis, prompt anticoagulation treatment and critical care may enhance favourable patient outcomes.
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Affiliation(s)
- Darshan Lal
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Arunodaya R Gujjar
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Nandagopal Ramachandiran
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ammar Obaidi
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Sunil Kumar
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Mortada El-Tigani
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Faizal Al-Azri
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Abdullah R Al-Asmi
- Department of Medicine, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
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Bushnaq SA, Qeadan F, Thacker T, Abbas M, Carlson AP. High-Risk Features of Delayed Clinical Progression in Cerebral Venous Thrombosis: A Proposed Prediction Score for Early Intervention. INTERVENTIONAL NEUROLOGY 2018; 7:297-307. [PMID: 30410505 DOI: 10.1159/000487960] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/23/2018] [Indexed: 11/19/2022]
Abstract
Background Anticoagulation is the mainstay treatment for cerebral venous thrombosis (CVT). A subset of patients might deteriorate despite anticoagulation, and in such cases, endovascular therapy is recommended. Methods A retrospective review was performed on subjects with CVT from January 2005 to October 2016. The primary outcome was clinical deterioration. Bivariate analysis, multiple logistic regression modeling, and linear discriminant analysis were used to determine a predictive model for deterioration; the results from these models were used to construct a CVT score in order to measure the individual likelihood of deterioration. Results We identified 147 subjects with CVT. The majority were treated with anticoagulation (n = 109, 74.15%); 38 (25.85%) were found to have deterioration, 12 (8.16%) of whom underwent endovascular intervention. The most important risk factors of deterioration, per bivariate analysis, included decreased level of consciousness (odds ratio [OR] = 5.76; 95% confidence interval [CI] 2.59-12.77) and papilledema (OR = 4.52; 95% CI 1.55-13.18). The final multivariable model also included CVT location score (number of sinuses involved), oral contraceptive pill use, sodium level, platelet count, and seizure activity on presentation. This model had a predictive ability to identify deterioration of 83.2%, with a sensitivity of 71.4% and a specificity of 76.2%. Patients with a CVT score of ≥5 have at least 50% chance of deterioration. Conclusions Decreased mental status, seizure activity, papilledema, number of involved sinuses, as well as sodium level and platelet count are the most important factors in predicting deterioration after CVT. This group may represent a subset of patients in whom early endovascular therapy may be considered.
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Affiliation(s)
- Saif A Bushnaq
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Fares Qeadan
- Clinical Translational Science Center, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Tapan Thacker
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Mohammad Abbas
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Andrew P Carlson
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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Combined aspiration thrombectomy and continuous intrasinus thrombolysis for cerebral venous sinus thrombosis: technical note and case series. Neuroradiology 2018; 60:1093-1096. [DOI: 10.1007/s00234-018-2084-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/16/2018] [Indexed: 11/26/2022]
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Cappuzzo JM, Hess RM, Morrison JF, Davies JM, Snyder KV, Levy EI, Siddiqui AH. Transverse venous stenting for the treatment of idiopathic intracranial hypertension, or pseudotumor cerebri. Neurosurg Focus 2018; 45:E11. [DOI: 10.3171/2018.5.focus18102] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEIdiopathic intracranial hypertension (IIH) is a commonly occurring disease, particularly among young women of child-bearing age. The underlying pathophysiology for this disease has remained largely unclear; however, the recent literature suggests that focal outflow obstruction of the transverse sinus may be the cause. The purpose of this study was to report one group’s early experience with transverse venous sinus stenting in the treatment of IIH and assess its effectiveness.METHODSThe authors performed a retrospective chart review to identify patients who had undergone stenting of an outflow-obstructed transverse venous sinus for the treatment of IIH at Gates Vascular Institute between January 2015 and November 2017. Patient demographic data of interest included age, sex, BMI, and history of smoking, hypertension, obstructive sleep apnea, hormonal contraceptive use, and acetazolamide therapy. Each patient’s presenting signs and symptoms and whether those symptoms improved with treatment were reviewed. The average opening lumbar puncture (LP) pressure preprocedure, average pressure gradient across the obstructed segment prior to stenting, treatment failure rate (need for shunt placement), and mean follow-up period were calculated.RESULTSOf the 18 patients who had undergone transverse venous stenting for IIH, 16 (88.9%) were women. The mean age of all the patients was 38.3 years (median 38 years). Mean BMI was 34.2 kg/m2 (median 33.9 kg/m2). Presenting symptoms were headache (16 patients [88.9%]), visual disturbances (13 patients [72.2%]), papilledema (8 patients [44.4%]), tinnitus (3 patients [16.7%]), and auditory bruit (3 patients [16.7%]). The mean opening LP pressure pre-procedure was 35.6 cm H2O (median 32 cm H2O). The mean pressure gradient measured proximally and distally to the area of focal obstruction within the transverse sinus was 16.5 cm H2O (median 15 cm H2O). Postprocedurally, 14 patients (77.8%) continued to have headaches; 6 (33.3%) continued to have visual disturbances. No patients continued to have auditory bruit (0%) or papilledema (0%). One patient (5.6%) had new-onset tinnitus postprocedure. Overall improvement of symptoms was noted in 16 patients (88.9%) postprocedure, with 1 patient (5.6%) requiring shunt placement and 2 other patients (11.1%) requiring postprocedural LP to monitor intracranial pressure to determine candidacy for further surgical interventions to treat residual symptoms. The mean duration of follow-up was 194.2 days.CONCLUSIONSTransverse sinus stenting is a rapidly developing technique that has shown good effectiveness and safety in the literature. Authors of the present study found that stenting a flow-obstructed transverse sinus in patients with IIH was a safe and effective way to treat the condition.
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Affiliation(s)
- Justin M. Cappuzzo
- Departments of 1Neurosurgery,
- 6Department of Neurosurgery, Gates Vascular Institute at Kaleida Health
| | - Ryan M. Hess
- 5Jacobs School of Medicine at the University at Buffalo
| | - John F. Morrison
- Departments of 1Neurosurgery,
- 6Department of Neurosurgery, Gates Vascular Institute at Kaleida Health
| | - Jason M. Davies
- Departments of 1Neurosurgery,
- 2Biomedical Informatics,
- 6Department of Neurosurgery, Gates Vascular Institute at Kaleida Health
- 8Jacobs Institute, Buffalo, New York
| | - Kenneth V. Snyder
- Departments of 1Neurosurgery,
- 3Neurology, and
- 6Department of Neurosurgery, Gates Vascular Institute at Kaleida Health
- 7Canon Stroke and Vascular Research Center at the University at Buffalo; and
| | - Elad I. Levy
- Departments of 1Neurosurgery,
- 4Radiology,
- 6Department of Neurosurgery, Gates Vascular Institute at Kaleida Health
- 7Canon Stroke and Vascular Research Center at the University at Buffalo; and
| | - Adnan H. Siddiqui
- Departments of 1Neurosurgery,
- 4Radiology,
- 6Department of Neurosurgery, Gates Vascular Institute at Kaleida Health
- 8Jacobs Institute, Buffalo, New York
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Roethlisberger M, Gut L, Zumofen DW, Fisch U, Boss O, Maldaner N, Croci DM, Taub E, Corti N, Burkhardt JK, Guzman R, Bozinov O, Mariani L. Cerebral venous thrombosis requiring invasive treatment for elevated intracranial pressure in women with combined hormonal contraceptive intake: risk factors, anatomical distribution, and clinical presentation. Neurosurg Focus 2018; 45:E12. [PMID: 29961388 DOI: 10.3171/2018.4.focus1891] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Women taking combined hormonal contraceptives (CHCs) are generally considered to be at low risk for cerebral venous thrombosis (CVT). When it does occur, however, intensive care and neurosurgical management may, in rare cases, be needed for the control of elevated intracranial pressure (ICP). The use of nonsurgical strategies such as barbiturate coma and induced hypothermia has never been reported in this context. The objective of this study is to determine predictive factors for invasive or surgical ICP treatment and the potential complications of nonsurgical strategies in this population. METHODS The authors conducted a 2-center, retrospective chart review of 168 cases of CVT in women between 2000 and 2012. Eligible patients were classified as having had a mild or a severe clinical course, the latter category including all patients who underwent invasive or surgical ICP treatment and all who had an unfavorable outcome (modified Rankin Scale score ≥ 3 or Glasgow Outcome Scale score ≤ 3). The Mann-Whitney U-test was used for continuous parameters and Fisher's exact test for categorical parameters, and odds ratios were calculated with statistical significance set at p ≤ 0.05. RESULTS Of the 168 patients, 57 (age range 16-49 years) were determined to be eligible for the study. Six patients (10.5%) required invasive or surgical ICP treatment. Three patients (5.3%) developed refractory ICP > 30 mm Hg despite early surgical decompression; 2 of them (3.5%) were treated with barbiturate coma and induced hypothermia, with documented infectious, thromboembolic, and hemorrhagic complications. Coma on admission, thrombosis of the deep venous system with consecutive hydrocephalus, intraventricular hemorrhage, and hemorrhagic venous infarction were associated with a higher frequency of surgical intervention. Coma, quadriparesis on admission, and hydrocephalus were more commonly seen among women with unfavorable outcomes. Thrombosis of the transverse sinus was less common in patients with an unfavorable outcome, with similar distribution in patients needing invasive or surgical ICP treatment. CONCLUSIONS The need for invasive or surgical ICP treatment in women taking CHCs who have CVT is partly predictable on the basis of the clinical and radiological findings on admission. The use of nonsurgical treatments for refractory ICP, such as barbiturate coma and induced hypothermia, is associated with systemic infectious and hematological complications and may worsen morbidity in this patient population. The significance of these factors should be studied in larger multicenter cohorts.
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Affiliation(s)
| | | | - Daniel Walter Zumofen
- Departments of1Neurosurgery and
- 2Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Basel and University of Basel, Basel
| | | | | | | | | | | | | | - Jan-Karl Burkhardt
- 5Department of Neurological Surgery, NYU School of Medicine, NYU Langone Medical Center, New York, New York
- 6Neurosurgery, University Hospital Zürich and University of Zürich, Zürich, Switzerland; and
| | | | - Oliver Bozinov
- 6Neurosurgery, University Hospital Zürich and University of Zürich, Zürich, Switzerland; and
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Zhang S, Hu Y, Li Z, Huang D, Zhang M, Wang C, Wang Z. Endovascular treatment for hemorrhagic cerebral venous sinus thrombosis: experience with 9 cases for 3 years. Am J Transl Res 2018; 10:1611-1619. [PMID: 30018704 PMCID: PMC6038069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/25/2018] [Indexed: 06/08/2023]
Abstract
AIM We experienced a series of patients with hemorrhagic CVST, who were successfully treated with endovascular treatment (EVT). The aim was to explore the best scheme for the future through our treatment data of hemorrhagic CVST. MATERIAL AND METHODS A retrospective analysis was conducted, selecting nine hemorrhagic CVST patients, who were mainly treated with EVT. Characteristics of hemorrhagic CVST were recorded, including risk factors, thrombus location, presenting symptoms, and treatment details included type of EVT. We also recorded clinical outcomes, degree of sinus recanalization, thrombus recurrences, periprocedural complications, degree of neurological deficit at last follow-up. RESULTS Catheter thrombolysis and mechanical thrombectomy were applied in all of the nine hemorrhagic CVST patients, stent retriever was used in 7 patients, one of them combined with balloon-assisted thrombectomy. Besides EVT, two patients accepted emergency surgical decompression, one in the local hospital, and the other in our hospital. The follow-up duration ranged from 4 to 28 months. All of them have a neurological and symptomatic improvement, 6 patients have a good outcome, the rest 3 patients have a poor outcome, no thrombus recurrences and death in them. Seven patients had complete recanalization and two patients had partial recanalization at last follow-up. CONCLUSION EVT is an effective and safe procedure for potentially catastrophic hemorrhagic cerebral venous sinus thrombosis.
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Affiliation(s)
- Shizhong Zhang
- Department of Neurosurgery, Qilu Hospital of Shandong UniversityNO. 758, Hefei Road, Shibei District, Qingdao 266035, Shangdong, China
- Department of Neurosurgery, Taian Central HospitalNO. 29, Longtan Road, Taian 271000, Shangdong, China
| | - Yanyan Hu
- Color Ultrasonic Room, Taian Central HospitalNO. 29, Longtan Road, Taian 271000, Shangdong, China
| | - Zhen Li
- Department of Neurosurgery, Taian Central HospitalNO. 29, Longtan Road, Taian 271000, Shangdong, China
| | - Dezhang Huang
- Department of Neurosurgery, Qilu Hospital of Shandong UniversityNO. 758, Hefei Road, Shibei District, Qingdao 266035, Shangdong, China
| | - Mingran Zhang
- Department of Neurosurgery, Taian Central HospitalNO. 29, Longtan Road, Taian 271000, Shangdong, China
| | - Chenglong Wang
- Department of Neurosurgery, Qilu Hospital of Shandong UniversityNO. 758, Hefei Road, Shibei District, Qingdao 266035, Shangdong, China
| | - Zhigang Wang
- Department of Neurosurgery, Qilu Hospital of Shandong UniversityNO. 758, Hefei Road, Shibei District, Qingdao 266035, Shangdong, China
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Lee SK, Mokin M, Hetts SW, Fifi JT, Bousser MG, Fraser JF. Current endovascular strategies for cerebral venous thrombosis: report of the SNIS Standards and Guidelines Committee. J Neurointerv Surg 2018; 10:803-810. [DOI: 10.1136/neurintsurg-2018-013973] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 11/03/2022]
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Chen C, Wang Q, Li X, Lu Z, He J, Fang Q, Ke X, Duan C, Li T. Stent retriever thrombectomy combined with local thrombolytic therapy for cerebral venous sinus thrombosis: A case report. Exp Ther Med 2017; 14:3961-3970. [PMID: 29067093 PMCID: PMC5647711 DOI: 10.3892/etm.2017.5043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 02/01/2017] [Indexed: 11/21/2022] Open
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.
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Affiliation(s)
- Chengwei Chen
- Department of Neurosurgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China.,The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, P.R. China
| | - Qiujing Wang
- The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, P.R. China.,Department of Neurosurgery, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong 518000, P.R. China
| | - Xifeng Li
- The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, P.R. China
| | - Ziming Lu
- The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, P.R. China
| | - Jian He
- The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, P.R. China
| | - Qinrui Fang
- The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, P.R. China
| | - Xunchang Ke
- The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, P.R. China
| | - Chuanzhi Duan
- The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, P.R. China
| | - Tielin Li
- The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, P.R. China
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Nyberg EM, Case D, Nagae LM, Honce JM, Reyenga W, Seinfeld J, Poisson S, Leppert MH. The Addition of Endovascular Intervention for Dural Venous Sinus Thrombosis: Single-Center Experience and Review of Literature. J Stroke Cerebrovasc Dis 2017; 26:2240-2247. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/23/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022] Open
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Matsuda Y, Okada H, Chung J, Webster Crowley R, Lopes DK. Novel balloon-and-aspiration method for cerebral venous sinus thrombosis: dental-floss technique. Neurosurg Focus 2017; 42:E19. [DOI: 10.3171/2017.1.focus16519] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cerebral venous sinus thrombosis is sometimes fatal. The standard treatment for sinus thrombosis is anticoagulation, but endovascular intervention must be considered when medical treatment fails. Mechanical thrombectomy is usually required when a large clot burden exits. Unfortunately, in sinus thrombosis attributable to a clot burden larger than that in an intracranial artery, the conventional technique used for intraarterial acute stroke intervention with a stent retriever and/or aspiration is not very effective. The authors describe here their endovascular approach to mechanical thrombectomy for sinus thrombosis using aspiration combined with angioplasty balloon support.
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Affiliation(s)
- Yoshikazu Matsuda
- 1Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
- 2Department of Neurosurgery, Wakayama Medical University
| | - Hideo Okada
- 1Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
- 3Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama City, Japan; and
| | - Joonho Chung
- 1Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
- 4Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - R. Webster Crowley
- 1Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
| | - Demetrius K. Lopes
- 1Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
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Ilyas A, Chen CJ, Raper DM, Ding D, Buell T, Mastorakos P, Liu KC. Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis: a systematic review. J Neurointerv Surg 2017; 9:1086-1092. [DOI: 10.1136/neurintsurg-2016-012938] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 12/26/2022]
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Cabral de Andrade G, Lesczynsky A, Clímaco VM, Pereira ER, Marcelino PO, Franco AOC, De Almeida DF. Cerebral venous sinuses thrombosis in both transverse sinus and torcula: Multistep endovascular treatment and stenting. Interv Neuroradiol 2017; 23:84-89. [PMID: 27798328 PMCID: PMC5305158 DOI: 10.1177/1591019916674917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 09/24/2016] [Accepted: 09/26/2016] [Indexed: 11/15/2022] Open
Abstract
Purpose Cerebral venous sinus thrombosis (CVST) is an unusual and potentially life-threatening condition with variable and nonspecific clinical symptoms and high morbimortality rates. Standard therapy consists of systemic anticoagulation; although there is no clear evidence about the best choice for treatment, intravenous heparin is used as the first-line treatment modality. Intravenous sinus thrombolysis can be an effective and relatively safe treatment for acutely deteriorating patients who have not responded to conventional therapy. This case report presents the possibility of endovascular treatment in multiple steps with mechanical thrombolysis with balloon, local pharmacological thrombolysis and stenting, in a patient with a severe form of CVST. Case summary A 67-year-old woman presented severe headache, agitation and confusion with diagnosis of venous sinus dural thrombosis in both lateral sinus and torcula. After 24 h there was neurological worsening evolving with seizures and numbness even after starting heparin, without sinus recanalization; CT scan showed left temporal intracerebral hemorrhage. We decided to take an endovascular approach in multiple steps. The first step was mechanical static thrombolysis with balloon; the second step was dynamic mechanical thrombolysis with a balloon partially deflated and "pulled"; the third step was local thrombolysis with Actilyse™; finally, the fourth step was angioplasty and reconstruction of the sinuses using multiple carotid stents and complete angiographic recanalization of both sinuses and torcula. After 24 h of endovascular treatment there was full clinical recovery and no tomographic complications. Conclusion This result shows that mechanical clot disruption, intrasinus thrombolysis and reconstruction of wall sinuses with stenting can be an endovascular option in the severe form of CVST with intracerebral hemorrhage and rapid worsening of neurological symptoms. Although this type of treatment can re-channel the occluded sinuses, further comparative and randomized studies are needed to clarify its efficacy versus other therapeutic modalities.
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Affiliation(s)
- G Cabral de Andrade
- CINN – Integrated Center of Neurology and Neurosurgery, Maringá, Brazil
- Parana Hospital, Maringá, Brazil
| | | | - VM Clímaco
- CINN – Integrated Center of Neurology and Neurosurgery, Maringá, Brazil
| | - ER Pereira
- CINN – Integrated Center of Neurology and Neurosurgery, Maringá, Brazil
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Ma J, Shui S, Han X, Guo D, Li TF, Yan L. Mechanical thrombectomy with Solitaire AB stents for the treatment of intracranial venous sinus thrombosis. Acta Radiol 2016; 57:1524-1530. [PMID: 26953230 DOI: 10.1177/0284185116633912] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Cerebral venous sinus thrombosis (CVST) is a rare clinicopathological entity with substantial diagnostic and therapeutic dilemmas. The appropriate management of CVST remains to be defined. Purpose To evaluate the efficiency and safety of mechanical thrombectomy with Solitaire AB stents for the treatment of intracranial venous sinus thrombosis. Material and Methods Twenty-three consecutive patients with CVST who were treated with mechanical thrombectomy using Solitaire AB stents between January 2013 and October 2014 were retrospectively analyzed. The headache intensity was evaluated according to the visual analogue scale (VAS), and neurological function was assessed using the National Institute of Health Stroke Scale (NIHSS). Follow-up data were available for all patients for 6-14 months. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) were performed at 3 and 6 months after neurointervention, and telephone interviews were performed monthly thereafter. The Wilcoxon signed-rank test was used to compare the evaluation data (VAS and NIHSS) at admission and discharge. Results Twenty-six Solitaire AB stents were used. No neurointervention-related complications were noted. The symptoms were significantly improved after neurointervention in all patients. The comparisons between the VAS and NIHSS evaluations at admission and discharge were significantly different ( P < 0.05). No recurrence was observed during the follow-up period. Conclusion Mechanical thrombectomy with Solitaire AB stents is safe and effective for the treatment of CVST and can significantly improve clinical symptoms. The occurrence of complications is low, and the prognosis is favorable.
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Affiliation(s)
- Ji Ma
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Shaofeng Shui
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - XinWei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Dong Guo
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Teng-Fei Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Lei Yan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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Bertolini G, Restelli F, Broggi M, Ferroli P. Letter to the Editor: Lateral sinus thrombosis: antithrombotic therapy and the issue of management of cerebellar swelling. J Neurosurg 2016; 126:336-338. [PMID: 27767402 DOI: 10.3171/2016.7.jns161729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Morgan Broggi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Paolo Ferroli
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Manzoor NF, Ray A, Singer J, Nord R, Sunshine J, Megerian CA, Bambakidis NC, Semaan MT. Successful endovascular management of venous sinus thrombosis complicating trans-labyrinthine removal of vestibular schwanomma. Am J Otolaryngol 2016; 37:379-82. [PMID: 27045766 DOI: 10.1016/j.amjoto.2016.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 01/27/2016] [Indexed: 10/22/2022]
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare complication of surgical treatment of vestibular schwanomma. We present a rare case of extensive venous sinus thrombosis after trans-labyrinthine approach that was refractory to systemic anti-coagulation. Mechanical aspiration thrombectomy was utilized to re-canalize the venous sinuses and resulted in successful resolution of neurological symptoms. Indications of utilizing endovascular approaches are discussed that will enable skull base surgeons to address this uncommon yet potentially fatal complication.
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Re: “Report of Dramatic Improvement after a Lumboperitoneal Shunt Procedure in a Case of Anticoagulation Therapy-Resistant Cerebral Venous Thrombosis”. J Stroke Cerebrovasc Dis 2016; 25:1557-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 02/17/2016] [Accepted: 02/25/2016] [Indexed: 11/20/2022] Open
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Report of Dramatic Improvement after a Lumboperitoneal Shunt Procedure in a Case of Anticoagulation Therapy-Resistant Cerebral Venous Thrombosis. J Stroke Cerebrovasc Dis 2015; 25:e15-9. [PMID: 26654661 DOI: 10.1016/j.jstrokecerebrovasdis.2015.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/05/2015] [Accepted: 10/23/2015] [Indexed: 11/21/2022] Open
Abstract
Cerebral venous thrombosis (CVT), which typically progresses from either acute or subacute onset, presents with symptoms related to intracranial hypertension (e.g., headache and papilledema) and brain parenchymal lesions (e.g., aphasia and hemiplegia). Anticoagulation therapy is generally accepted as a treatment for CVT and often leads to good clinical outcomes. However, we experienced a case of CVT with an uncommon clinical course. The patient was a 63-year-old man who presented with headache, papilledema, visual loss, and diplopia; his condition gradually deteriorated, and he was diagnosed with CVT via cerebral angiography. The sinus thrombus was extensive and resistant to anticoagulation therapy, and lumbar puncture revealed a progressive increase in cerebrospinal fluid (CSF) pressure. We performed a lumboperitoneal (LP) shunt procedure, which yielded marked improvement in the symptoms. The main mechanism of neurological dysfunction in CVT is venous outflow obstruction caused by venous thrombus, which results in brain edema, and/or venous infarction, which induces focal neurological signs. Another mechanism is impaired CSF absorption in the thrombosed sinuses, resulting in intracranial hypertension. We speculated that the latter mechanism strongly influenced our case, thus explaining the uncommon clinical course and effectiveness of the LP shunt procedure. Although LP shunting is not a common treatment for CVT, this case report could indicate the usefulness of this procedure for CVT with chronic progression and resistance to anticoagulation therapy.
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