Direct endovascular thrombolytic therapy for dural sinus thrombosis: infusion of alteplase.
OBJECTIVE
To evaluate the efficacy, safety, and results of direct thrombolytic therapy in intracranial dural sinus thrombosis by infusion of alteplase (recombinant tissue plasminogen activator).


METHODS
Nine patients were treated during a 2-year period for intracranial dural sinus thrombosis. A microcatheter was placed directly into the thrombus in the dural sinus via the transfemoral route. Thrombolysis was initiated with a rapid injection of 10 mg of alteplase over 10 minutes, followed in 3 hours by a continuous infusion of 50 mg, then a continuous infusion at 5 mg per hour until complete thrombolysis or a total dose of 100 mg per day had been reached. Repeat thrombolysis was tried the following day if complete recanalization did not occur at 100 mg per day.


RESULTS
Successful recanalization with improvement of symptoms was achieved in all cases. Time required for complete thrombolysis was between 8 and 43 hours. The total dose of alteplase ranged from 50 to 300 mg. Complications of a small intrapelvic hemorrhage and oozing at a femoral puncture site occurred in separate cases, but were not related to the amount of infused alteplase. MR venograms obtained 1 to 4 weeks after the procedure showed no evidence of reocclusion of the dural sinuses.


CONCLUSIONS
Direct fibrinolytic therapy with alteplase is safe, fast, and effective in treating dural sinus thrombosis. However, to prevent hemorrhagic complications, further studies are required to determine its optimal dose and proper rate of administration.
Kim
S Y
SY
Department of Diagnostic Radiology, Ajou University, School of Medicine, Suwon, Korea.
Suh
J H
JH
D000328:Adult; D002404:Catheterization / Q000295:instrumentation; D004388:Dura Mater; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D015552:Injections, Intralesional / Q000295:instrumentation; D018810:Magnetic Resonance Angiography; D008297:Male; D008845:Microinjections / Q000295:instrumentation; D008875:Middle Aged; D010388:Pelvis; D010690:Phlebography; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011677:Punctures / Q000009:adverse effects; D019233:Retreatment; D012449:Safety; D012851:Sinus Thrombosis, Intracranial / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000295:instrumentation / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014654:Vascular Patency
D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator