Interventional neuroradiology in the treatment of cerebral venous thrombosis

Heparin is the standard of care in cerebral venous thrombosis. Local thrombolysis is believed to better restore venous blood flow than heparin. Thrombolysis is also used when the patient's condition worsens despite heparin and symptomatic treatment. The most frequently described cause of worsening is inadequate anticoagulation. Clinical deterioration due to thrombosis progression in properly anticoagulated patients is rarely observed. When it is observed, thrombolytic treatment should be considered as a valid option. This is so, even in the absence of clear evidence from randomized trials that clinical outcome is superior. Furthermore, in theory, hemorrhagic risk is higher in thrombolysis compared to heparin, especially when a pretreatment hemorrhage is already present. Thus, this fear that hemorrhagic stroke can deteriorate due to thrombolysis treatment leads to the development of improved mechanical techniques that lower the risk of bleeding. One of these devices is rheolytic thrombectomy, which utilizes the Venturi effect which creates a negative pressure fragmenting and aspirating the cerebral venous thrombus. These devices can be utilized in combination with thrombolysis. The interventional neuroradiology data published until now are promising. However, whether interventional radiology is more effective or safer than heparin therapy even in patients who can be treated by heparin can only be answered by randomized controlled trials. There is no reason to recommend interventional radiology in these patients who are likely to have a good outcome unless proven superior in a trial.