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Endovascular treatments for cerebral venous sinus thrombosis

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Abstract

Cerebral venous sinus thrombosis (CVST) is an uncommon but potentially fatal condition. CVST usually occurs young adults with a female predominance. The current mainstay for treating CVST is anticoagulation with heparin. However, more aggressive interventions, endovascular treatment as an example, may be indicated in selected patients who are non-responsive to heparin and other anticoagulants. Endovascular approaches include catheter-based local chemical thrombolysis, balloon angioplasty and mechanical thrombectomy, all of which may rapidly recanalize the occluded venous sinus, restore the blood flow, reduce the increased intracranial pressure, and subsequently relieve the corresponding symptoms. However, as an invasive strategy, endovascular procedures per se may cause complications, such as intracranial hemorrhage, vessel dissection and pulmonary embolization, which may substantially decrease the benefit–risk ratio of the treatment. Due to the rareness of the condition and the limited indication of this invasive strategy, safety and efficacy of endovascular procedures in treating CVST are less feasible to be evaluated in large randomized clinical trails. Therefore, the evidences for justifying this treatment strategy are largely derived from case reports, cohort studies and clinical observations.

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    Authors and Affiliations

    1. Department of Neurology, Jinling Hospital, Second Military Medical University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China

      Zhongming Qiu & Gelin Xu

    2. Department of Neurology, The 117th Hospital of PLA, 14 Lingyin Road, Xihu District, Hangzhou, 310013, Zhejiang Province, China

      Zhongming Qiu

    3. Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China

      Hongfei Sang, Qiliang Dai & Gelin Xu

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    Correspondence to Gelin Xu.

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    Zhongming Qiu and Hongfei Sang have contributed equally to this work.

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    Qiu, Z., Sang, H., Dai, Q. et al. Endovascular treatments for cerebral venous sinus thrombosis. J Thromb Thrombolysis 40, 353–362 (2015). https://doi.org/10.1007/s11239-015-1205-7

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