title: Extensive experience with dural sinus thrombosis.
abstract: OBJECTIVE
  Dural sinus thrombosis (DST) is an uncommon cause of stroke. The safest and most effective therapy for DST has not been conclusively identified.
  
  
  METHODS
  A retrospective chart review of data for 31 patients who were treated for DST at our institution between 1992 and 2001 was performed. Four treatment strategies were identified, i.e., 1). medical observation only, 2). systemic anticoagulation (AC) therapy with heparin, 3). endovascular chemical thrombolysis with urokinase or tissue plasminogen activator and concurrent systemic AC therapy, and 4). mechanical endovascular clot thrombolysis with concurrent systemic AC therapy. Complications and clinical outcomes were assessed for each group.
  
  
  RESULTS
  Patients treated solely with medical observation fared the worst; four of five patients experienced intracranial hemorrhagic complications, and only two of five exhibited clinical improvement. Patients who received systemic AC therapy experienced no hemorrhagic complications, even when pretreatment hemorrhage was present; 75% (six of eight patients) exhibited improvement with AC therapy alone. Chemical thrombolysis was very effective in restoring sinus patency (90% of patients); however, 30% of patients (3 of 10 patients) experienced hemorrhagic complications. Sixty percent of patients (6 of 10 patients) who underwent chemical thrombolysis exhibited clinical improvement. Patients who underwent mechanical thrombectomies demonstrated a low hemorrhagic complication rate, and most (88%) made good recoveries.
  
  
  CONCLUSIONS
  Therapy directed at the underlying clot in DST must begin without delay. Our results suggest that supportive medical management of DST, without therapy directed at the clot or clotting process, is not effective. Systemic AC therapy, even in the presence of intracerebral hemorrhage, seems to be safe. Heparin can be safely titrated to yield partial thromboplastin times of 60 to 70 seconds. Chemical clot thrombolysis is efficacious in opening occluded sinuses but may cause intracranial hemorrhage. We currently recommend either systemic AC therapy or systemic AC therapy in conjunction with mechanical clot thrombectomy as a safe effective treatment for DST.
authors.affiliation: Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84132-2303, USA. Scott.Soleau@m.cc.utah.edu
authors.forename: Scott W
authors.initials: SW
authors.lastname: Soleau
authors.forename: Richard
authors.initials: R
authors.lastname: Schmidt
authors.forename: Steve
authors.initials: S
authors.lastname: Stevens
authors.forename: Anne
authors.initials: A
authors.lastname: Osborn
authors.forename: Joel D
authors.initials: JD
authors.lastname: MacDonald
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000601:surgery*; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010960:Plasminogen Activators / Q000627:therapeutic use*; D011859:Radiography; D012189:Retrospective Studies; D012851:Sinus Thrombosis, Intracranial / Q000150:complications / Q000188:drug therapy* / Q000601:surgery*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D006493:Heparin; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator