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Endovascular thrombolysis for pediatric cerebral sinus venous thrombosis with tissue plasminogen activator and
Imad S Khan1, Travis R Ladner, Komal F Satti
1Departments of Neurosurgery and.
Insights
This study reports a novel endovascular approach for severe cerebral sinus venous thrombosis (CSVT) in a pediatric patient, using tissue plasminogen activator (tPA) with abciximab for successful recanalization.
Area of Science:
- Neurology
- Vascular Medicine
- Pediatric Critical Care
Background:
- Cerebral sinus venous thrombosis (CSVT) is a rare but serious condition.
- Standard treatment involves systemic anticoagulation, but some patients require more aggressive therapies.
- Severe CSVT necessitates advanced management strategies beyond conventional anticoagulation.
Observation:
- A pediatric patient with severe CSVT underwent successful recanalization via endovascular therapy.
- The treatment involved the use of endovascular tissue plasminogen activator (tPA) combined with abciximab.
- This represents a novel approach, as abciximab has not been previously reported in conjunction with tPA for CSVT endovascular thrombolysis.
Findings:
- Successful recanalization was achieved in the pediatric patient treated with endovascular tPA and abciximab.
- Literature review indicates varied outcomes for pediatric CSVT patients undergoing endovascular thrombolysis.
- The combination of tPA and abciximab may be beneficial for hypercoagulable states requiring acute recanalization and long-term venous patency.
Implications:
- The combined use of tPA and abciximab offers a potential treatment option for severe pediatric CSVT, particularly in hypercoagulable patients.
- This approach may improve acute recanalization and long-term venous patency in select CSVT cases.
- Careful consideration of hemorrhagic risks is crucial when employing adjunctive agents like abciximab in endovascular thrombolysis.
Abstract:
Cerebral sinus venous thrombosis (CSVT) is a relatively rare but potentially devastating disease. Medical management of CSVT with systemic anticoagulation has been the mainstay treatment strategy with these patients. However, some patients may not respond to this treatment or may present with very severe symptoms indicating more aggressive management strategies. The authors present the case of a pediatric patient who presented with severe CSVT, who underwent successful recanalization with endovascular tissue plasminogen activator (tPA) and abciximab. To the authors' knowledge there are no cases of endovascular thrombolysis for CSVT described in the literature in which abciximab has been used in conjunction with tPA. The authors also review the literature regarding the agents used and outcome in pediatric patients with CSVT after endovascular thrombolysis. The use of abciximab in conjunction with tPA may be considered in patients whose blood is hypercoagulable and in whom the treatment strategy is to obtain acute recanalization and long-term venous patency. However, the use of adjunctive agents increases the risk of hemorrhagic complications and must be done judiciously.
