title: Continuous thrombolysis and repeated thrombectomy with the Penumbra System in a child with hemorrhagic sinus thrombosis: technical note.
abstract: Cerebral venous sinus thrombosis (CVST) is an uncommon but potentially lethal event. When showing a malignant clinical course despite anticoagulant therapy, new endovascular techniques and technology allow the possibility of more aggressive thrombolysis and thrombectomy. The authors present a case of recanalization of an extensive cerebral thrombosis using a new endovascular thromboaspiration device, the Penumbra System.
  
  
  OBJECTIVE
  CVST in children is a rare but potentially lethal disorder. When showing a malignant progression despite anticoagulant therapy, the use of local thrombolytics and thrombectomy procedures might provide therapeutic solution.
  
  
  METHODS
  A 16-year-old girl presented with signs and symptoms of a hemorrhagic cerebral sinus thrombosis and showed progression despite full dose anticoagulant therapy. The evolution being attributed to increasing mass effect, decompressive surgery was performed without clinical improvement. Further brain imaging demonstrated progression of the sinus thrombosis. Repeated local thrombectomy with the Penumbra thrombectomy system and continuous, relatively low dose local thrombolysis was performed during a period of 60 h, resulting in recanalization and clinical improvement. The methodology of combined thromboaspiration and thrombolysis is described.
  
  
  CONCLUSIONS
  We present a novel method for revascularization using the Penumbra System in combination with long-term, relatively low dose thrombolysis, in the setting of both clinically and morphologically progressive, hemorrhagic sinus thrombosis. The procedure proved to be both safe and effective and may be considered in the future for patients with progressive sinovenous thrombosis despite adequate medical therapy.
authors.affiliation: Department of Interventional Neuroradiology, National Neuroscience Institute, Budapest, Hungary. kulcsarzsolt22@gmail.com
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Kulcsár
authors.forename: Miklós
authors.initials: M
authors.lastname: Marosfoi
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Berentei
authors.forename: István
authors.initials: I
authors.lastname: Szikora
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000627:therapeutic use; D002545:Brain Ischemia / Q000209:etiology / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003392:Cranial Sinuses / Q000187:drug effects / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D010690:Phlebography; D012851:Sinus Thrombosis, Intracranial / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator