Adjunctive rheolytic thrombectomy for central venous sinus thrombosis: technical case report.
OBJECTIVE
Patients with dural sinus thrombosis occasionally present with a malignant clinical course marked by parenchymal hemorrhage accompanied by either a severe neurological deficit or a persistent deterioration on therapeutic levels of antithrombotic medications. This scenario precludes traditional revascularization strategies with direct fibrinolytic infusion because of the risk of exacerbating the preexisting cerebral hemorrhage. In the current series, we describe our experience using the AngioJet (Possis Medical, Minneapolis, MN), a rheolytic mechanical thrombectomy device, in conjunction with systemic heparinization to achieve rapid sinus revascularization without fibrinolytic therapy.


METHODS
A retrospective review of a prospectively maintained database identified four patients ranging in age from 28 to 67 years (three women, one man) with cerebral venous thrombosis and rapidly deteriorating levels of consciousness who underwent transfemoral intravenous rheolytic thrombectomy using the AngioJet XMI and/or Xpeedior catheters (Possis Medical). The imaging features, treatment specifications, and disease outcome were reviewed.


RESULTS
All four patients underwent successful mechanical thrombectomy as indicated by restoration of blood flow through the affected sinuses. Three of the four patients demonstrated normalization of angiographic transit time after thrombectomy. In these three patients, rapid neurological improvement ensued. The fourth patient died during the periprocedural period. No procedural complications were encountered.


CONCLUSIONS
Systemic heparinization with adjunctive rheolytic thrombectomy (without fibrinolytic therapy) is a safe and effective treatment strategy for selected patients with dural venous sinus thrombosis.
Kirsch
Jacobo
J
Department of Neuroradiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Rasmussen
Peter A
PA
Masaryk
Thomas J
TJ
Perl
John
J
Fiorella
David
D
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000295:instrumentation / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012851:Sinus Thrombosis, Intracranial / Q000188:drug therapy* / Q000601:surgery*; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
D000925:Anticoagulants; D006493:Heparin