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Combined intraarterial and intravenous thrombolysis for severe cerebral venous sinus thrombosis

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Abstract

To investigate the safety and efficacy of endovascular therapy with combined intra-arterial and intravenous thrombolysis for severe cerebral venous sinus thrombosis. Of the 28 consecutive patients with cerebral venous sinus thrombosis admitted to our hospital in recent 3 years, six patients underwent combined intra-arterial and intravenous thrombolysis. For each patient, local contact thrombolysis was performed with balloon catheter to break clot and urokinase infused for thrombolysis in sinus. At the same time, urokinase (100,000 IU/h) was infused intra-arterially via internal carotid artery to dissolve the venous thrombi. Neurologic outcomes, Glasgow coma scale (GCS), neuroimaging results and modified Rankin Scale score (mRS) were recorded. Of the six treated patients, two were males and four females. Their mean age was 38 ± 13 (range from 22 to 57) years. Completely recanalization was observed in five patients, whose clinical symptoms recovered completely (mRS score 0). One patient in whom thrombolysis was delayed died the day after the procedure. Endovascular treatment with combined intra-arterial and intravenous thrombolysis may improve neurological outcomes of severe cerebral venous sinus thrombosis.

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Abbreviations

CSVT:

Cerebral sinus venous thrombosis

CT:

Computed tomography

GCS:

Glasgow coma scale

ICT:

Intracranial circulation time

mRS:

Modified Rankin Scale score

SSS:

Superior sagittal sinus

STS:

Straight sinus

TS:

Tranverse sinus

SS:

Sigmoid sinus

References

  1. Bousser MG, Ferro JM (2007) Cerebral venous thrombosis: an update. Lacet Neurol 6:162–170

    Article  CAS  Google Scholar 

  2. Bousser MG (2000) Cerebral venous thrombosis diagnosis and management. J Neurol 247:252–258

    Article  CAS  PubMed  Google Scholar 

  3. Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F (2004) Prognosis of cerebral vein and dural sinus thrombosis: results of the international study on cerebral vein and dural sinus thrombosis (ISCVT). Stroke 35:664–670

    Article  PubMed  Google Scholar 

  4. Ciccone A, Canhão P, Falcão F, Ferro JM, Steri R (2004) Thrombolysis for cerebral vein and dural sinus thrombosis. Stroke 35:2428

    Article  Google Scholar 

  5. Sujith OK, Krishnan R, Asraf V, Rahman A, Girija AS (2008) Local thrombolysis in patients with dural venous thrombosis unresponsive to heparin. J Stroke Cerebrovasc Dis 17:95–100

    Article  CAS  PubMed  Google Scholar 

  6. 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 39:1487–1490

    Article  PubMed  Google Scholar 

  7. Newman CB, Pakbaz RS, Nguyen AD, Kerber CW (2000) Endovascular treatment of extensive cerebral sinus thrombosis. J Neurosurg 110:442–445

    Google Scholar 

  8. Renowden S (2000) Cerebral venous thrombosis: local thrombolysis. J R Soc Med 93:241–243

    CAS  PubMed  Google Scholar 

  9. Frey JL, Muro GJ, McDougall CG, Dean BL, Jahnke HK (1999) Cerebral venous thrombosis: combined intrathrombus rtPA and intravenous heparin. Stroke 30:489–494

    CAS  PubMed  Google Scholar 

  10. Girot M, Ferro JM, Canhão P, Stam J, Bousser MG (2007) Predictors of outcome in patients with cerebral venous thrombosis and intracerebral hemorrhage. Stroke 38:337–342

    Article  PubMed  Google Scholar 

  11. Canhão P, Ferro JM, Lindgren AG, Bousser MG, Stam J, Barinagarrementeria F (2005) Causes and predictors of death in cerebral venous thrombosis. Stroke 36:1720–1725

    Article  PubMed  Google Scholar 

  12. Mehraeina S, Schmidtkeb K, Villringera A, Valduezaa JM, Masuhra F (2003) Heparin treatment in cerebral sinus and venous thrombosis: patients at risk of fatal outcome. Cerebrovasc Dis 15:17–21

    Article  Google Scholar 

  13. Chow K, Gobin P, Saver J, Kidwell C, Dong P, Viñuela F (2000) Endovascular treatment of dural sinus thrombosis with rheolytic thrombectomy and intra-arterial thrombolysis. Stroke 31:1420–1425

    CAS  PubMed  Google Scholar 

  14. Song JK, Eskridge JM (2000) Intracranial angioplasty and thrombolysis. Neuroendovasc Surg 11:49–65

    CAS  Google Scholar 

  15. Kim SY, Suh JH (1997) Direct endovascular thrombolytic therapy for dural sinus thrombosis: infusion of alteplase. Am J Neuroradiol 18:639–645

    CAS  PubMed  Google Scholar 

  16. de Bruijn SF, de Haan RJ, Stam J (2001) Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients: for the cerebral venous sinus thrombosis study group. J Neurol Neurosurg Psychiatry 70:105–108

    Article  PubMed  Google Scholar 

  17. Novak Z, Coldwell DM, Brega KE (2000) Selective infusion of Urokinase and thrombectomy in the treatment of acute cerebral sinus thrombosis. Am J Neuroradiol 21:143–145

    CAS  PubMed  Google Scholar 

  18. Curtin KR, Shaibani A, Resnick SA, Russell EJ, Russell EJ, Simuni T (2004) Rheolytic catheter thrombectomy, balloon angioplasty, and direct recombinant tissue plasminogen activator thrombolysis of dural sinus thrombosis with preexisting hemorrhagic infarctions. Am J Neuroradiol 25:1807–1811

    PubMed  Google Scholar 

  19. Prasad RS, Michaels LA, Roychowdhury S, Craig V, Sorrell A, Schonfeld S (2006) Combined venous sinus angioplasty and low dose thrombolytic therapy for treatment of hemorrhagic tranverse sinus thrombosis in a padiatric patient. J Pediatr Hematol Oncol 28:196–199

    Article  PubMed  Google Scholar 

  20. Yamashita S, Mastumoto Y, Tamiya T, Kawanishi M, Shindo A, Nakamura T et al (2005) Mechanical thrombolysis for treatment of acute sinus thrombosis: case report. Neuro Med Chir (Tokyo) 45:635–639

    Article  Google Scholar 

  21. Tsai FY, Kostanian V, Rivera M, Lee KW, Chen CC, Nguyen TH (2007) Cerebral venous congestion as indication for thrombolytic treatment. Cardiovasc Intervent Radiol 30:675–687

    Article  PubMed  Google Scholar 

  22. Liebetrau M, Mayer TE, Bruning R, Opherk C, Hamann GF (2004) Intra-arterial thrombolysis of complete deep cerebral venous thrombosis. Neurology 63:2444–2445

    CAS  PubMed  Google Scholar 

  23. Villringer A, Mehraein S, Einhäupl KM (1994) Pathophysiological aspects of cerebral sinus venous thrombosis. J Neuroradiol 21:72–80

    CAS  PubMed  Google Scholar 

  24. Masuhr F, Mehraein S, Einhäupl K (2004) Cerebral venous and sinus thrombosis. J Neurol 251:11–23

    Article  CAS  PubMed  Google Scholar 

  25. Cao XY, Li BM, Li S, Wang J (2006) Effects of injecting Urokinase via carotid artery in treatment of cerebral venous sinus thrombosis: an experiment with rabbit models. Chung-Hua i Hsueh Tsa Chih (Chinese Med J) 86:745–748

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, 305# East Zhongshan Road, 210002, Nanjing, Jiangsu Province, People’s Republic of China

    Xuanye Yue, Zhiming Zhou, Gelin Xu & Xinfeng Liu

  2. Department of Neurology, Shiyan People’s Hospital, Yunyang Medical College, Shiyan, Hubei Province, China

    Xuanye Yue & Gangming Xi

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  1. Xuanye Yue
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  2. Gangming Xi
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  3. Zhiming Zhou
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  4. Gelin Xu
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  5. Xinfeng Liu
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Correspondence to Xinfeng Liu.

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Yue, X., Xi, G., Zhou, Z. et al. Combined intraarterial and intravenous thrombolysis for severe cerebral venous sinus thrombosis. J Thromb Thrombolysis 29, 361–367 (2010). https://doi.org/10.1007/s11239-009-0386-3

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  • DOI: https://doi.org/10.1007/s11239-009-0386-3

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