Advertisement

Neuroradiology

, Volume 60, Issue 10, pp 1093–1096 | Cite as

Combined aspiration thrombectomy and continuous intrasinus thrombolysis for cerebral venous sinus thrombosis: technical note and case series

  • Anderson Chun On Tsang
  • A. C. Hwang
  • R. H. Y. Chiu
  • D. Y. C. Chan
  • F. C. P. Tsang
  • W. S. Ho
  • R. Lee
  • G. K. K. Leung
  • W. M. Lui
Short Report
  • 72 Downloads

Abstract

Cerebral venous sinus thrombosis is an uncommon cause of stroke with high morbidity and mortality rates from venous infarction, intracranial hemorrhage, and extensive cerebral edema. Endovascular treatment with various devices has been proposed as a salvage treatment when standard medical treatment with systemic anticoagulation is ineffective, especially in long segment dural sinus thrombosis. We describe our technique of transvenous endovascular aspiration thrombectomy with large bore thrombectomy catheters, followed by placement of microcatheter for local thrombolytic infusion at the site of thrombosis. We report a retrospective study of angiographic and clinical outcome of six consecutive patients treated with this approach. Endovascular aspiration thrombectomy with large bore catheters followed by continuous local thrombolytic infusion appeared to be a safe and effective salvage treatment for selected patients with cerebral dural venous sinus thrombosis refractory to medical treatment.

Keywords

Venous sinus thrombosis Thrombectomy Thrombolysis 

Notes

Compliance with ethical standards

Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

For this type of retrospective study formal consent is not required.

References

  1. 1.
    Coutinho JM (2015) Cerebral venous thrombosis. J Thromb Haemost 13(Suppl 1):S238–S244.  https://doi.org/10.1111/jth.12945 CrossRefPubMedGoogle Scholar
  2. 2.
    Ferro JM, Bousser MG, Canhao P, Coutinho JM, Crassard I, Dentali F, di Minno M, Maino A, Martinelli I, Masuhr F, Aguiar de Sousa D, Stam J (2017) European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. Eur J Neurol 24(10):1203–1213.  https://doi.org/10.1111/ene.13381 CrossRefPubMedGoogle Scholar
  3. 3.
    Ilyas A, Chen CJ, Raper DM, Ding D, Buell T, Mastorakos P, Liu KC (2017) Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis: a systematic review. J Neurointerv Surg 9(11):1086–1092.  https://doi.org/10.1136/neurintsurg-2016-012938 CrossRefPubMedGoogle Scholar
  4. 4.
    Li LF, Pu JK, Tsang CP, Tsang AC, Lui WM, Leung GK (2017) Iatrogenic sigmoid sinus occlusion rescued by graft repair and endovascular thrombolysis. World Neurosurg 104:1047 e1013–1047 e1017.  https://doi.org/10.1016/j.wneu.2017.05.041 CrossRefGoogle Scholar
  5. 5.
    Stam J, Majoie CB, van Delden OM, van Lienden KP, Reekers JA (2008) Endovascular thrombectomy and thrombolysis for severe cerebral sinus thrombosis: a prospective study. Stroke 39(5):1487–1490.  https://doi.org/10.1161/strokeaha.107.502658 CrossRefPubMedGoogle Scholar
  6. 6.
    Siddiqui FM, Banerjee C, Zuurbier SM, Hao Q, Ahn C, Pride GL, Wasay M, Majoie CB, Liebeskind D, Johnson M, Stam J (2014) Mechanical thrombectomy versus intrasinus thrombolysis for cerebral venous sinus thrombosis: a non-randomized comparison. Interv Neuroradiol 20(3):336–344.  https://doi.org/10.15274/nrj-2014-10032 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Siddiqui FM, Dandapat S, Banerjee C, Zuurbier SM, Johnson M, Stam J, Coutinho JM (2015) Mechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases. Stroke 46(5):1263–1268.  https://doi.org/10.1161/strokeaha.114.007465 CrossRefPubMedGoogle Scholar
  8. 8.
    Liao W, Liu Y, Gu W, Yang J, Chen C, Liu F, Zeng F, Wang X (2015) Cerebral venous sinus thrombosis: successful treatment of two patients using the penumbra system and review of endovascular approaches. Neuroradiol J 28(2):177–183.  https://doi.org/10.1177/1971400915576633 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Dashti SR, Hu YC, Yao T, Fiorella D, Mitha AP, Albuquerque FC, McDougall CG (2013) Mechanical thrombectomy as first-line treatment for venous sinus thrombosis: technical considerations and preliminary results using the AngioJet device. J Neurointerv Surg 5(1):49–53.  https://doi.org/10.1136/neurintsurg-2011-010112 CrossRefPubMedGoogle Scholar
  10. 10.
    Mokin M, Lopes DK, Binning MJ, Veznedaroglu E, Liebman KM, Arthur AS, Doss VT, Levy EI, Siddiqui AH (2015) Endovascular treatment of cerebral venous thrombosis: contemporary multicenter experience. Interv Neuroradiol 21(4):520–526.  https://doi.org/10.1177/1591019915583015 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Neurosurgery, Department of Surgery, Queen Mary HospitalThe University of Hong KongHong KongHong Kong
  2. 2.Li Ka Shing Faculty of MedicineThe University of Hong KongPok Fu LamHong Kong
  3. 3.Department of Diagnostic RadiologyQueen Mary HospitalPok Fu LamHong Kong

Personalised recommendations