Endovascular mechanical thrombectomy combined with continuous intrasinus thrombolysis for the treatment of severe hemorrhagic cerebral venous sinus thrombosis: a case series study
10.3760/cma.j.issn.1673-4165.2023.07.005
- VernacularTitle:血管内机械血栓切除术联合持续窦内溶栓治疗严重出血性脑静脉窦血栓形成：病例系列研究
- Author:
Lijuan HAN
1
;
Qixuan LU
;
Yun XU
;
Jingwei LI
;
Liping LIU
Author Information
1. 南京大学医学院附属鼓楼医院神经内科，南京 210009
- Keywords:
Sinus thrombosis, intracranial;
Intracranial hemorrhages;
Endovascular procedures;
Thrombectomy;
Thrombolytic therapy;
Urokinase-type plasminogen activator
- From:
International Journal of Cerebrovascular Diseases
2023;31(7):512-518
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the feasibility and safety of endovascular mechanical thrombectomy (EMT) combined with continuous intrasinus thrombolysis for the treatment of severe hemorrhagic cerebral venous sinus thrombosis (CVST).Methods:The clinical and imaging data of 5 consecutive patients with severe hemorrhagic CVST who received EMT combined with continuous intrasinus urokinase thrombolysis in Beijing Tiantan Hospital from March 2019 to February 2020 were retrospectively analyzed.Results:The average age of 5 patients was 39 years (range, 19-65 years). Two were males and 3 were females. Risk factors associated with CVST were identified in 3 patients. Four had more than two venous sinuses involved, with a total of 10 blood vessels affected by CVST. The affected venous sinus thrombus burden was high, the lesion volume was large, and the clinical manifestations were severe. The average duration of heparin anticoagulation therapy before EMT was 2.3 d (range, 0.5-7 d), and the average duration of intrasinus thrombolysis was 64 h (range, 30-95 h). After treatment, 1 vessel was completely recanalized and 7 vessels were partially recanalized. Four patients who achieved recanalization had good long-term clinical outcomes (modified Rankin Scale score: 0-2 at 3 months, 0-1 at 1 year). One patient failed to achieve recanalization and underwent decompressive craniectomy due to intracranial hypertension, had residual hemiparesis at 1-year follow-up. No procedure-related complications occurred.Conclusion:EMT combined with continuous intrasinus thrombolysis is a potential treatment option for patients with severe hemorrhagic CVST.
