Local Intrasinus Thrombolysis for Cerebral Venous Sinus Thrombosis

Cerebral venous strokes due to cerebral venous sinus thrombosis (CVST) have varied presentation and clinical outcome. Despite aggressive medical treatment with optimal anticoagulation, some patients develop progressive neurologic deterioration causing significant morbidity and mortality. The aim of the present series is to analyze the safety and efficacy of in situ thrombolysis in patients with cerebral venous sinus thrombosis in severe clinical grade and refractory to conventional medical management.

Twenty-nine patients with cerebral venous thrombosis who received in situ thrombolysis during a 3-year period (April 2013 to April 2016) were included in the study. Tissue plasminogen activator (tpa) was used in all the patients. The lytic agent was infused into the sinus via the micro catheter. Data regarding demographic, clinical, and radiologic features were analyzed in all the patients.

Recanalization of the affected sinuses was achieved in all the cases. Twenty-four patients had good outcome (mRs 0 or1) and three patients had mild deficits (mRs 2). One patient had moderate disability (mRs 3). One patient succumbed due to increased hematoma causing midline shift and transtentorial herniation. At 3 months follow-up, 26 patients were asymptomatic and two patients had minor symptoms.

Local intrasinus thrombolysis (LIST) is safe and effective method in patients with poor clinical grade and the present study highlights the benefit of thrombolysis, particularly in patients unresponsive to anticoagulation. The improved efficacy of this therapy depends on early recognition of worsening symptoms and timely intervention.