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Paybast S, Mohamadian R, Emami A, Jameie M, Shahrab F, Zamani F, Sharifipour E. Safety and efficacy of endovascular thrombolysis in patients with acute cerebral venous sinus thrombosis: A systematic review. Interv Neuroradiol 2022:15910199221143418. [PMID: 36471504 DOI: 10.1177/15910199221143418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Cerebral venous sinus thrombosis (CVST) is an uncommon but fatal cause of stroke worldwide. Endovascular treatments could be life-saving in patients who don't treat with anticoagulants as a mainstay of treatment. Currently, there is no consensus considering the safety, efficacy, and also selected approaches of endovascular intervention for these patients. This systematic review evaluates the literature on endovascular thrombolysis (EVT) in CVST patients. MATERIALS AND METHODS A comprehensive search was conducted through PubMed and Scopus databases between 2010 and 2021, with additional sources identified through cross-referencing. The primary outcomes were the safety and efficacy of EVT in CVST, including catheter-related and non-catheter-related complications, clinical outcomes, and radiological outcomes. RESULTS A total of 10 studies comprising 339 patients were included. Most of the patients presented with headaches (86.72%) and/or focal neurologic deficits (45.43%) (modified Rankin Scale of 5 in 55.88%). Acquired coagulopathy and/or consuming estrogen/progesterone medication were the most frequent predisposing factors (45.59%). At presentation, 68.84% had multi-sinus involvement, and 28.90% had venous infarcts and/or intracranial hemorrhage (ICH). The overall complication rate was 10.3%, with a 2.94%, 1.47%, and 1.17% rate of ICH, herniation, and intracranial edema, respectively. The complete and partial postoperative radiographic resolution was reported in 89.97% of patients, increasing to 95.21% during the follow-up. Additionally, 72.22% of patients had no or mild neurologic deficit at discharge, rising to 91.18% at the last follow-up. The overall mortality rate was 7.07%. CONCLUSIONS EVT can be an effective and safe treatment option for patients with refractory CVST or contraindications to systemic anticoagulation.
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Affiliation(s)
- Sepideh Paybast
- Neurology Department and Stroke Unit, Shohada-Tajrish Tertiary University Hospital, 48504Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Mohamadian
- Radiology Department, 87255Eastern Clinical University Hospital, Stradins University, Riga, Latvia
| | - Ali Emami
- Research Committee, 48491Qazvin University of Medical Sciences, Qazvin, Iran
| | - Melika Jameie
- Neurology Department and Stroke Unit, Shohada-Tajrish Tertiary University Hospital, 48504Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereshteh Shahrab
- 154202Neuroscience Research Center of Qom University of Medical Sciences, Qom, Iran
| | - Farideh Zamani
- 154202Neuroscience Research Center of Qom University of Medical Sciences, Qom, Iran
| | - Ehsan Sharifipour
- Neurology Department and Stroke Unit, Shohada-Tajrish Tertiary University Hospital, 48504Shahid-Beheshti University of Medical Sciences, Tehran, Iran
- 154202Neuroscience Research Center of Qom University of Medical Sciences, Qom, Iran
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Zhang K, Li TX, Gao BL, Zhu LF, Wang ZL. Endovascular recanalization of extensively-thrombosed cerebral venous sinuses in early pregnancy: A case report. Medicine (Baltimore) 2022; 101:e30266. [PMID: 36086789 PMCID: PMC10980448 DOI: 10.1097/md.0000000000030266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/15/2022] [Indexed: 11/25/2022] Open
Abstract
RATIONALE The incidence of pregnancy-related cerebral venous sinus thrombosis (CVST) is rare, and cerebral hemorrhage caused by CVST in the early pregnancy period is even rarer. Only 3 cases of cerebral hemorrhage caused by CVST had been reported in the early pregnancy period in the literature. In this study, we reported successful endovascular treatment of such a case. PATIENT CONCERNS A 27-year-old woman presented with rapidly progressive neurologic decline in her second pregnancy for 8 weeks. She was afebrile and completely conscious, without neurological deficits. She did not have any previous history of venous thrombosis, hematologic, or autoimmune diseases. DIAGNOSIS Urgent brain computed tomography demonstrated parietal-occipital hemorrhage surrounded by a large hypodense area and full brain swelling. Magnetic resonance venography showed complete occlusion of the right sigmoid sinus, transverse sinus, and two-thirds of the superior sagittal sinus. Transvaginal sonography demonstrated early intrauterine pregnancy, with the size of gestation sac being 6 × 7 × 6 mm and the fetal heart not being detected. CVST-related cerebral hemorrhage was confirmed based on the clinical and imaging data. INTERVENTIONS The CVST in this pregnant woman was treated endovascularly with a 6 Fr Navien catheter for aspiration, thrombolysis, and anticoagulation. OUTCOMES Ten days after treatment, the cerebral hemorrhage had gradually been absorbed. Follow-up angiography performed 2 weeks later demonstrated complete recanalization of her cortical veins and sinuses. Two months later, the patient was completely recovered without cognitive or neurological dysfunction. LESSONS Pregnancy-related CVST can be successfully treated with a combined endovascular approach of aspiration, thrombolysis, and anticoagulation to complete recovery.
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Affiliation(s)
- Kun Zhang
- Cerebrovascular Center, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Tian-Xiao Li
- Cerebrovascular Center, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Bu-Lang Gao
- Cerebrovascular Center, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Liang-Fu Zhu
- Cerebrovascular Center, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Zi-Liang Wang
- Cerebrovascular Center, Henan Provincial People’s Hospital, Zhengzhou University, Zhengzhou, Henan Province, China
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Ye Y, Ding J, Liu S, Huang S, Li Z, Yang J, Huang J. Impacts on Thrombus and Chordae Willisii During Mechanical Thrombectomy in the Superior Sagittal Sinus. Front Neurol 2021; 12:639018. [PMID: 33746891 PMCID: PMC7970025 DOI: 10.3389/fneur.2021.639018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/26/2021] [Indexed: 11/15/2022] Open
Abstract
The anatomical structures of the superior sagittal sinus (SSS) are usually damaged during mechanical thrombectomy (MT), and MT procedure could lead to new thrombosis in the sinuses. However, the mechanism remains unclear. We aimed to investigate the risks of embolism and assess the damage to chordae willisii (CW)-associated MT using a stent passing across the thrombus. A contrast-enhanced in vitro model was used to mimick MT in the SSS. The thrombus was removed with a stent. The emboli generated during the procedure were collected and measured. The residual thrombus area after the MT was measured by J Image software. The damage of CW was evaluated by an endoscope. Three procedural experiments were carried out on each cadaveric sample. The average numbers of visible emboli particles in experiments 1, 2, and 3 were 11.17 ± 2.17, 9.00 ± 2.07, and 5.00 ± 2.96, respectively. The number of large size particles produced by experiment 1 was significantly higher than that of the other experiments. The thrombus area measured after experiment 3 was larger than that of experiments 1 and 2. The number of minor damage cases to CW was 55 (90.16%), and there were six serious damage cases (9.84%). The use of stent resulted in no significant increase in damage to CW after the three experimental procedures. A large amount of thrombi particles was produced during MT, and multiple MT procedures on the same sample can increase residual thrombus area. Moreover, the stent caused minor damages to the CW in SSS.
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Affiliation(s)
- Yuanliang Ye
- Department of Neurosurgery, Liuzhou People's Hospital, Liuzhou, China
| | - Jiuyang Ding
- School of Forensic Medicine, Guizhou Medical University, Guiyang, China
| | - Shoutang Liu
- Department of Neurosurgery, Liuzhou People's Hospital, Liuzhou, China
| | - Shaoming Huang
- Department of Anatomy, Guangxi Medical University, Nanning, China
| | - Zhu Li
- School of Forensic Medicine, Guizhou Medical University, Guiyang, China
| | - Jianqing Yang
- Department of General Surgery, Liuzhou People's Hospital, Liuzhou, China
| | - Jiang Huang
- School of Forensic Medicine, Guizhou Medical University, Guiyang, China
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Simonin A, Rusca M, Saliou G, Levivier M, Daniel RT, Oddo M. Multimodal Regional Brain Monitoring of Tissue Ischemia in Severe Cerebral Venous Sinus Thrombosis. Neurocrit Care 2019; 31:297-303. [PMID: 30805844 DOI: 10.1007/s12028-019-00695-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Comatose critically ill patients with severe diffuse cerebral venous thrombosis (CVT) are at high risk of secondary hypoxic/ischemic insults, which may considerably worsen neurological recovery. Multimodal brain monitoring (MBM) may therefore improve patient care in this setting, yet no data are available in the literature. METHODS We report two patients with coma following severe diffuse CVT who underwent emergent invasive MBM with intracranial pressure (ICP), brain tissue oximetry (PbtO2), and cerebral microdialysis (CMD). Therapy of CVT consisted of intravenous unfractionated heparin (UFH), followed by endovascular mechanical thrombectomy (EMT). EMT efficacy was assessed continuously at the bedside using MBM. RESULTS Despite effective therapeutic UFH (aPTT two times baseline levels in the two subjects), average CMD levels of lactate and glucose in the 6 h prior to EMT displayed evidence of regional brain ischemia. The EMT procedure was associated with a rapid (within 6 h) improvement in both CMD lactate (6.42 ± 0.61 4.89 ± 0.55 mmol/L, p = 0.02) and glucose (0.49 ± 0.17 vs. 0.96 ± 0.32 mmol/L, p = 0.0005). EMT was also associated with a significant increase in PbtO2 (22.9 ± 7.5 vs. 30.1 ± 3.6 mmHg, p = 0.0003) and a decrease in CMD glutamate (12.69 ± 1.06 vs. 5.73 ± 1.76 μmol/L, p = 0.017) and intracranial pressure (ICP) (13 ± 4 vs. 11 ± 4 mmHg (p = 004). Patients did not require surgical decompression, regained consciousness, and were discharged from the hospital with a good neurological outcome (modified Rankin score 3 and 4). CONCLUSIONS This study illustrates the potential utility of continuous bedside MBM in patients with coma after severe brain injury, irrespective of the primary acute cerebral condition. Despite adequate ICP and PbtO2 control, the presence of CMD signs of regional brain cell ischemia triggered emergent EMT to treat CVT, which was associated with a significant and clinically relevant improvement of intracerebral physiology.
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Affiliation(s)
- Alexandre Simonin
- Neurosurgery, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Rue du Bugnon 21, Lausanne, Switzerland.
| | - Marco Rusca
- Department of Intensive Care Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Guillaume Saliou
- Neuroradiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Marc Levivier
- Neurosurgery, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Rue du Bugnon 21, Lausanne, Switzerland
| | - Roy Thomas Daniel
- Neurosurgery, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Rue du Bugnon 21, Lausanne, Switzerland
| | - Mauro Oddo
- Department of Intensive Care Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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Konakondla S, Schirmer CM, Li F, Geng X, Ding Y. New Developments in the Pathophysiology, Workup, and Diagnosis of Dural Venous Sinus Thrombosis (DVST) and a Systematic Review of Endovascular Treatments. Aging Dis 2017; 8:136-148. [PMID: 28400981 PMCID: PMC5362174 DOI: 10.14336/ad.2016.0915] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 09/15/2016] [Indexed: 12/28/2022] Open
Abstract
Dural venous sinus thrombosis (DVST) is a rare cause of stroke, which typically affects young women. The importance of identifying pre-disposing factors that lead to venous stasis lies in the foundation of understanding the etiology, pathophysiology and clinical presentation. The precise therapeutic role of interventional therapies is not fully understood though the current data do suggest potential applications. The aim of the study was to perform a systematic review and meta-analysis to evaluate the utility of and short-term 30-day survival after endovascular therapy for patients with DVST. Standard PRISMA guidelines were followed. Data sources included PubMed keywords and phrases, which were also incorporated into a MeSH search to yield articles indexed in Medline over a 5-year period. All RCTs, observational cohort studies, and administrative registries comparing or reporting DVST were included. Sixty-six studies met inclusion criteria. 35 articles investigating treatment in a summation of 10,285 patients were eligible for data extraction and included in the review of treatment modalities. A total of 312 patients were included for statistical analysis. All patients included received endovascular intervention with direct thrombolysis, mechanical thrombectomy or both. 133 (42.6%) patients were documented to have a neurologic decline, which prompted endovascular intervention. All patients who had endovascular interventions were those who were started on and failed systemic anticoagulation. 44 patients were reported to have intracranial hemorrhages after intervention. Regardless of systemic anticoagulation, patients were still reported to have complications of VTE and PE. Primary outcome at 3-6 month follow up revealed mRS<1 in 224 patients. DVST presents with many diagnostic and therapeutic challenges. The utility of invasive interventions such as local thrombolysis and mechanical thrombectomy is not fully understood. It is exceedingly difficult to conduct large randomized trials for this low incidence disease process with large pathophysiological heterogeneity.
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Affiliation(s)
- Sanjay Konakondla
- 1 Department of Neurosurgery, Geisinger Health System, Danville, PA 17822, USA
| | - Clemens M Schirmer
- 1 Department of Neurosurgery, Geisinger Health System, Danville, PA 17822, USA
| | - Fengwu Li
- 2 Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiaogun Geng
- 2 Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China; 3 Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Yuchuan Ding
- 3 Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI 48201, USA
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