Rheolytic thrombectomy for cerebral sinus thrombosis.
BACKGROUND
Cerebral venous and sinus thrombosis (CVST) is an uncommon cause of stroke that is associated with poor outcomes in high-risk patients who present with stupor or coma, rapidly progressive neurologic deficits or progressive neurologic deficits during therapeutic anticoagulation.


RESULTS
We report the rapid treatment of CVST in six patients at high risk for poor outcomes (death or dependency) using rheolytic thrombectomy combined with locally administered low-dose recombinant tissue plasminogen activator (rt-PA), and review the literature on rheolytic thrombectomy for CVST. All of the procedures were technically successful. No complications occurred. Two patients experienced partial rethrombosis following rheolytic thrombectomy requiring a second treatment. Preexisting hemorrhagic infarcts in two patients remained stable. Two of six patients experienced excellent clinical outcomes. Two had good outcomes. There were two deaths from irreversible cerebral injury caused by extensive CVST that had occurred prior to the endovascular treatments. In 24 cases of rheolytic thrombectomy for CVST that were reviewed from this series and previously published reports, the large majority of patients experienced good to excellent clinical outcomes.


CONCLUSIONS
Extensive CVST in high-risk patients can be rapidly fatal. Rheolytic thrombectomy combined with locally administered, low-dose recombinant tissue plasminogen activator (rt-PA) is a safe and effective endovascular method to rapidly recanalize the intracranial dural sinuses in high-risk patients with CVST.
Zhang
Aijun
A
Department of Neurosurgery, Jinan Central Hospital, Shandong University, Jinan, Shandong 250013, P.R. China.
Collinson
Randi L
RL
Hurst
Robert W
RW
Weigele
John B
JB
D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012212:Rheology; D012307:Risk Factors; D012851:Sinus Thrombosis, Intracranial / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator