Page:Intrasinus Thrombolysis for Cerebral Venous Sinus Thrombosis - Single-Center Experience.pdf/1

 in Neurology

Xinbin Guo,* Jiachen Sun, Xiaoke Lu and Sheng Guan*

Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzou, China

Objective: The purpose of this research was to study the safety and efficacy of intrasinus thrombolysis in patients with cerebral venous thrombosis unresponsive to conventional heparin therapy.

Methods: A total of 156 CVST patients were treated using interventional thrombolysis in our center from January 2010 to June 2018. Clinical data, including duration of symptoms, indications and outcome of IST were retrieved, and outcomes were analyzed. DSA or MRV was used to assess the recanalization after thrombolysis. mRS was used to evaluate the outcome at admission, discharge, and follow-up.

Results: 91.38% of patients obtained functional independence (mRS 0-2). The mRS score was 0-2 in 120 patients (76.92%, 120/156) at the time of discharge. Seven patients succumbed during hospitalization. MRV extension was performed in 149 patients, and the results showed that the venous sinus of 112 patients (75.17%) was completely recanalized, and it was partially recanalized in 28 patients (18.79%) and nine patients (6.04%) had no recanalization at the time of discharge. In total, 116 patients were followed up for at least 6 months, 89 patients (76.72%) were completely recanalized, 21 patients (18.1%) were partially recanalized, and six patients (5.17%) were not recanalized.

Conclusion: IST may be more effective than systemic heparin anticoagulation in moribund and unresponsive patients despite the risk of hemorrhage. Large randomized controlled trials are required to further evaluate this issue.

Keywords: cerebral venous sinus thrombosis, intrasinus thrombolysis, safety, validity, anticoagulant

Cerebral Venous Sinus Thrombosis (CVST) is an uncommon disease with an annual incidence of 0.5-1%, but could cause potentially life-threatening ischemic stroke, especially among young women. Typical clinical symptoms of CVST include headaches, blurred vision, limb paralysis, conscienceness disorder, and coma. Due to the various clinical presentations, the misdiagnosis rate of CVST is relatively high and the mortality rate of severe CVST is 10-30%.

Anticoagulant therapy is the first line of treatment for CVST. Although most patients respond very well to treatment with heparin, some patients might undergo an adverse course with subsequent worse outcomes. The subgroup of patients with poor outcome are those with coma, intracerebral hemorrhage (ICH), rapidly progressing clinical deficits, and involvement of the deep venous system. Approximately 30% of patients with one or more of these risk factors had Frontiers in Neurology