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Stent retriever thrombectomy combined with local thrombolytic therapy for cerebral venous sinus thrombosis: A case

Chengwei Chen1,2, Qiujing Wang2,3, Xifeng Li2

  • 1Department of Neurosurgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China.

Experimental and Therapeutic Medicine
|October 26, 2017
PubMed

Insights

Successful treatment of cerebral venous sinus thrombosis (CVST) was achieved using stent retriever thrombectomy and local thrombolysis. This combined therapy significantly improved patient outcomes and venous sinus recanalization compared to standard anticoagulation alone.

Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Vascular Medicine

Background:

  • Cerebral venous sinus thrombosis (CVST) is a serious condition often treated with anticoagulation.
  • Escalation of therapy may be necessary for patients with severe symptoms or poor response to anticoagulation.
  • Endovascular techniques offer potential treatment options for complex CVST cases.

Purpose of the Study:

  • To evaluate the efficacy and safety of stent retriever thrombectomy combined with local thrombolytic therapy for treating acute cerebral venous sinus thrombosis (CVST).
  • To compare the outcomes of endovascular therapy versus standard anticoagulation in patients with CVST.

Main Methods:

  • Retrospective analysis of 29 patients diagnosed with CVST via MRV or DSA.
  • Group A (14 patients): received stent retriever thrombectomy with local thrombolysis, +/- stent-assisted angioplasty for stenosis.
  • Group B (15 patients): received systemic anticoagulation therapy, including warfarin.
  • Assessment of clinical presentation, recanalization rates, Glasgow Coma Scale, and modified Rankin Scale (mRS) at 12-month follow-up.

Main Results:

  • Complete venous sinus recanalization was achieved in 71.4% of patients in Group A versus 6.7% in Group B.
  • Clinical symptoms improved in 12/14 patients treated with endovascular therapy.
  • Improved mRS scores were observed in both groups at 12-month follow-up compared to admission.
  • Intracranial hemorrhage occurred in 2 patients following endovascular procedures.

Conclusions:

  • Stent retriever thrombectomy combined with local thrombolytic therapy is a favorable treatment option for acute CVST.
  • This endovascular approach is particularly beneficial for patients with cortical venous outflow stasis or neurological deterioration despite anticoagulation.
  • The combined therapy demonstrated superior recanalization rates and positive clinical outcomes.

Keywords:
cerebral venous sinus thrombosisstent retrieverthrombectomythrombolytictreatment

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