title: A Series of Cerebral Venous Sinus Thromboses Treated with Intra-Arterial tPA infused over Ten Hours with a 0.027-inch Catheter and Literature Review.
abstract: Cerebral venous sinus thrombosis (CVST) can have devastating results, with mortality reported in 44% of cases. No randomized trials exist in order to define what qualifies as failure of conservative therapy, and there is no specific intervention to date which is considered safe and effective. Case series suggest that thrombolysis infusion is safer than thrombectomy, but methods of administration, dose, and duration of therapy tend to vary widely. We present three consecutive CVST patients treated with heparin who suffered both clinical and radiographic deterioration, and went on to have endovascular therapy. Each patient was successfully recanalized by placing a 0.027-inch microcatheter at the proximal portion of the thrombus and infusing 20 mg of alteplase dissolved in 1 liter of normal saline infused at 100 ml per hour for an infusion of 2 mg of alteplase per hour for ten hours.
authors.affiliation: Department of Neurosurgery, Penn State Hershey Medical Center.
authors.forename: Endrit
authors.initials: E
authors.lastname: Ziu
authors.affiliation: Neural and Behavioral Science, Penn State Hershey Medical Center.
authors.forename: O'Hara
authors.initials: O
authors.lastname: Haley
authors.affiliation: Neurology, Penn State Hershey Medical Center.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ibrahimi
authors.affiliation: Department of Neurosurgery, Penn State Hershey Medical Center.
authors.forename: Sara
authors.initials: S
authors.lastname: Langan
authors.affiliation: Department of Neurosurgery, Penn State Hershey Medical Center.
authors.forename: Scott
authors.initials: S
authors.lastname: Simon
keywords: cerebral venous sinus thrombosis; thrombolytic infusion