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Published on: July 9, 2020
[A case report of severe cerebral sinus thrombosis treated by mechanical disruption using rheolytic catheter with
Kazutomo Nakazawa1, Fujimoto Motoaki, Mitsushige Ando
1Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Insights
Mechanical clot disruption effectively treated cerebral sinus thrombosis with large hematomas. This procedure, combined with anticoagulation, led to significant patient recovery and improved neurological outcomes.
Area of Science:
- Neurology
- Interventional Neuroradiology
Background:
- Cerebral sinus thrombosis (CST) can lead to severe neurological deficits and is often treated conservatively or with thrombolysis.
- Large intraparenchymal hematomas associated with CST pose significant management challenges.
Observation:
- A 61-year-old male presented with consciousness disorders, bilateral frontal subarachnoid hemorrhage (SAH), and a right temporo-parietal hematoma.
- Despite conservative management, the patient's condition worsened with hematoma enlargement.
- Angiography revealed extensive sinus thrombosis involving the superior sagittal and bilateral transverse sinuses.
Findings:
- Mechanical clot disruption using PTA balloons and a rheolytic catheter was performed via the right internal jugular vein under systemic anticoagulation.
- Excellent angiographic results were achieved, demonstrating successful clot removal.
- The patient showed gradual recovery, with only residual upper quadrant hemianopsia at six months post-treatment.
Implications:
- Mechanical clot disruption combined with systemic anticoagulation appears to be a safe and effective treatment for cerebral sinus thrombosis, particularly in patients with large associated intraparenchymal hematomas.
- This approach offers a promising alternative for complex CST cases refractory to conservative measures.
- Further research into optimizing mechanical thrombectomy techniques for CST is warranted.
Abstract:
A 61-year-old man presented with consciousness disorders. Computed tomography revealed bilateral frontal SAH and hematoma in the right temporo-parietal region. His condition deteriorated despite conservative treatment and hematoma became enlarged. The angiographic diagnosis was extensive sinus thrombosis from the superior sagittal sinus to the bilateral transverse sinus. Therefore, mechanical clot disruption was performed under systemic anticoagulation using PTA balloons catheter and a rheolytic catheter via the right internal jugular vein. Excellent angiographic results were obtained, and the patient recovered gradually. Six months after treatment, the patient had only upper quadrant hemianopsia and no other neurologic deficit. Our experience suggests that mechanical clot disruption with systemic anticoagulation as a safe effective treatment for cerebral sinus thrombosis, especially in patient whom had large intraparenchymal hematoma.
