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Can mechanical thrombectomy be effective in deep cerebral venous thrombosis worsening on anticoagulant? Insight from
Marine Glineur1, Anne Dusart2, Nicolas Cavez2
1Service de neurologie, Hôpital Erasme, Brussels, Belgium; Service de neurologie, CHU de Charleroi, Chaussée de Bruxelles, 140, Charleroi 6042, Belgium.
Insights
Mechanical thrombectomy (MT) may be a viable rescue treatment for severe cerebral venous thrombosis (CVT) that worsens despite anticoagulation. This approach showed significant clinical and radiological improvement in two challenging deep venous system CVT cases.
Area of Science:
- Neurology
- Vascular Medicine
- Interventional Neuroradiology
Background:
- Cerebral venous thrombosis (CVT) presents with diverse neurological symptoms, from headaches to altered consciousness.
- Deep venous system involvement in CVT often portends a poor prognosis, even with optimal anticoagulation.
- The efficacy of rescue mechanical thrombectomy (MT) for refractory CVT remains uncertain.
Observation:
- Two patients with deep venous system CVT showed no improvement with standard anticoagulation.
- Both patients experienced remarkable clinical and radiological recovery following MT.
Findings:
- Mechanical thrombectomy led to a spectacular response in two cases of severe CVT unresponsive to anticoagulation.
- These results suggest MT can be effective in specific, deteriorating CVT scenarios.
Implications:
- Mechanical thrombectomy could be considered a rescue therapy for select patients with severe cerebral venous thrombosis.
- Further research is warranted to define the precise role and optimal timing of MT in CVT management.
- These findings challenge the broad interpretation of negative trials like TO-ACT regarding MT in CVT.
Objective:
Cerebral venous thrombosis (CVT) is a rare condition whose clinical presentation can range from simple headaches to severe impairment of alertness. Some clinical forms, such as involvement of the deep venous system, are associated with a poorer clinical prognosis despite well-managed anticoagulation. The role and timing of rescue mechanical thrombectomy for these patients is not well established.
Method:
Clinical and imaging follow-up are discussed according to our treatment decision.
Results:
We describe two cases with deep venous system thrombosis that were treated unsuccessfully with optimal anticoagulation, with a spectacular clinical and radiological response after mechanical thrombectomy (MT).
Conclusion:
These cases demonstrate that, despite the negative results of the TO-ACT trial, MT could be considered as a rescue treatment in some clinical forms of deteriorating CVT despite optimal anticoagulation.
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