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Safety and Validity of Mechanical Thrombectomy and Thrombolysis on Severe Cerebral Venous Sinus Thrombosis

Li, Guangwen MD*,‡; Zeng, Xianwei MD*,§; Hussain, Mohammed PhD*,‖; Meng, Ran MD‡,¶; Liu, Yi PhD; Yuan, Kevin PhD; Sikharam, Chaitanya PhD; Ding, Yuchuan PhD; Ling, Feng MD; Ji, Xunming MD, PhD

Neurosurgery:
doi: 10.1227/NEU.0b013e318285c1d3
Research-Human-Clinical Studies
Abstract

BACKGROUND: Although the majority of patients with cerebral venous sinus thrombosis (CVST) obtain an optimistic clinical outcome after heparin or warfarin treatment, there remains a subgroup of patients who do not respond to conventional anticoagulation treatment. These patients, especially younger people, as documented by hospital-based studies, have a high morbidity and mortality rate.

OBJECTIVE: To verify the safety and efficacy of a dual mechanical thrombectomy with thrombolysis treatment modality option in patients with severe CVST.

METHODS: Fifty-two patients diagnosed with CVST were enrolled and treated with mechanical thrombectomy combined with thrombolysis. Patients underwent urokinase 100 to 1500 × 103 IU intravenous sinus injection via a jugular catheter after confirming diagnoses of CVST by using either magnetic resonance imaging/magnetic resonance venography or digital subtract angiography. Information obtained on the patients included recanalization status of venous sinuses as evaluated by magnetic resonance venography or digital subtract angiography at admission, during operation, and at 3- and 6-month follow-up after treatment.

RESULTS: The percentage of patients that showed complete and partial recanalization were 87% and 6%, respectively, after mechanical thrombectomy combined with thrombolysis treatment; 8% of the patients showed no recanalization. The modified Rankin Scale scores were 1.0 ± 0.9, 0.85 ± 0.63, and 0.37 ± 0.53 for discharge, and 3- and 6-month follow-up, respectively. A total of 6 patients died despite receiving aggressive treatment. No cases of relapse occurred after 3 to 6 months of follow-up.

CONCLUSION: Thrombectomy combined with thrombolysis is a safe and valid treatment modality to use in severe CVST cases or in intractable patients that have shown no adequate response to antithrombotic drugs.

ABBREVIATIONS: CVST, cerebral venous sinus thrombosis

DSA, digital subtract angiography

mRS, modified Rankin Scale

MRV, magnetic resonance venography

Author Information

China (Xuanwu Hospital) - America (Massachusetts General Hospital) Joint Institute of Neuroscience, CAJIN, Xuanwu Hospital, Capital Medical University, Beijing, China

§Department of Neurosurgery, Affiliated Hospital of Weifang Medical College, Weifang, China

Cerebral Vascular Diseases Institute, Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan

Department of Neurology, Beijing Xuanwu Hospital affiliated to Capital Medical University, Beijing, China

Correspondence: Xunming Ji, MD, PhD, and Feng Ling, MD, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, 100053, China. E-mail: Jixm@ccmu.edu.cn and lingfeng_cmu@sina.cn

* These authors have contributed equally to this article.

Received September 07, 2012

Accepted December 18, 2012

Copyright © by the Congress of Neurological Surgeons