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Rheolytic thrombectomy for cerebral sinus thrombosis
Aijun Zhang1, Randi L Collinson, Robert W Hurst
1Department of Neurosurgery, Jinan Central Hospital, Shandong University, Jinan, Shandong 250013, P.R. China.
Insights
Rheolytic thrombectomy with low-dose rt-PA offers a safe and effective endovascular treatment for severe cerebral venous and sinus thrombosis (CVST). This rapid recanalization improves outcomes in high-risk patients with CVST.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Cerebral venous and sinus thrombosis (CVST) is a rare but serious condition, often leading to poor outcomes in high-risk patients.
- Patients with stupor, coma, or rapidly progressing neurological deficits during anticoagulation are particularly vulnerable.
Observation:
- This study reports on six high-risk CVST patients treated with rheolytic thrombectomy and low-dose recombinant tissue plasminogen activator (rt-PA).
- The procedure achieved rapid recanalization of intracranial dural sinuses with no complications.
- Two patients required a second treatment due to partial rethrombosis; preexisting hemorrhagic infarcts remained stable.
Findings:
- Two patients achieved excellent outcomes, and two had good outcomes.
- Two deaths occurred due to extensive CVST prior to treatment.
- A review of 24 cases, including this series, indicates that rheolytic thrombectomy generally leads to good or excellent outcomes.
Implications:
- Rheolytic thrombectomy combined with rt-PA is a safe and effective endovascular strategy for managing extensive CVST.
- Rapid recanalization of dural sinuses can significantly improve clinical outcomes in high-risk CVST patients.
- This approach offers a critical treatment option for a condition with historically poor prognosis.
Introduction:
Cerebral venous and sinus thrombosis (CVST) is an uncommon cause of stroke that is associated with poor outcomes in high-risk patients who present with stupor or coma, rapidly progressive neurologic deficits or progressive neurologic deficits during therapeutic anticoagulation.
Methods And Results:
We report the rapid treatment of CVST in six patients at high risk for poor outcomes (death or dependency) using rheolytic thrombectomy combined with locally administered low-dose recombinant tissue plasminogen activator (rt-PA), and review the literature on rheolytic thrombectomy for CVST. All of the procedures were technically successful. No complications occurred. Two patients experienced partial rethrombosis following rheolytic thrombectomy requiring a second treatment. Preexisting hemorrhagic infarcts in two patients remained stable. Two of six patients experienced excellent clinical outcomes. Two had good outcomes. There were two deaths from irreversible cerebral injury caused by extensive CVST that had occurred prior to the endovascular treatments. In 24 cases of rheolytic thrombectomy for CVST that were reviewed from this series and previously published reports, the large majority of patients experienced good to excellent clinical outcomes.
Conclusions:
Extensive CVST in high-risk patients can be rapidly fatal. Rheolytic thrombectomy combined with locally administered, low-dose recombinant tissue plasminogen activator (rt-PA) is a safe and effective endovascular method to rapidly recanalize the intracranial dural sinuses in high-risk patients with CVST.
