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Prabasara HKDK, Niwunhella K, Vidanagamage A, De Silva H, Dahanayaka M. Cerebral Venous Sinus Thrombosis Mimicking Tumor Hemorrhage: Successful Anticoagulation in a Resource-Limited Setting. Cureus 2025; 17:e83918. [PMID: 40371182 PMCID: PMC12076267 DOI: 10.7759/cureus.83918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2025] [Indexed: 05/16/2025] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare yet potentially reversible etiology of stroke that frequently presents with nonspecific symptoms, contributing to delayed diagnosis. Aphasia, commonly associated with arterial infarcts, may also occur in CVST when thrombosis involves cortical veins responsible for language function. We report a case of a middle-aged female who presented with expressive aphasia and headache. Initial non-contrast computed tomography (CT) revealed hemorrhagic changes suggestive of tumor-related bleed. However, subsequent magnetic resonance venography (MRV) confirmed CVST involving the left transverse sinus. Anticoagulation with low molecular weight heparin (LMWH) was initiated despite the presence of hemorrhagic venous infarction and was well tolerated, leading to progressive clinical improvement. This case underscores the diagnostic challenges posed by CVST when imaging mimics neoplastic hemorrhage and highlights the importance of early venographic imaging. Timely recognition and initiation of anticoagulation, even in the presence of hemorrhage, remain critical to achieving favorable outcomes.
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Affiliation(s)
| | | | | | - Hirushaka De Silva
- Anaesthesiology, District General Hospital - Hambantota, Hambantota, LKA
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Gautam D, Shoraka O, Nguyen S, Bounajem MT, Shoskes A, Majersik JJ, Rennert RC, Kilburg C, Budohoski KP, Grandhi R. Endovascular treatment of cerebral venous sinus thrombosis: A systematic review and meta-analysis of efficacy based on technique. Interv Neuroradiol 2025:15910199251336946. [PMID: 40296709 PMCID: PMC12040881 DOI: 10.1177/15910199251336946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Accepted: 04/07/2025] [Indexed: 04/30/2025] Open
Abstract
BackgroundCerebral venous sinus thrombosis (CVST) is rare but potentially life-threatening. Although systemic anticoagulation is the primary treatment, endovascular thrombectomy (EVT) or thrombolysis may be considered for refractory cases. Considering advanced techniques and device technology, we undertook an updated systematic review and meta-analysis to evaluate clinical and radiographic outcomes for treating CVST.MethodsWe searched PubMed and EMBASE for studies describing CVST patients treated with EVT. Presenting symptoms, procedural details, and clinical and radiographic outcomes were analyzed. Random-effects models were generated to calculate pooled proportions of clinical and radiographic outcome variables.ResultsWe analyzed 26 studies comprising 273 patients (mean age 37 years, 57.7% female). Preprocedural intracranial hemorrhage was present in 167/243 (67.1%) patients. Endovascular thrombectomy techniques included aspiration thrombectomy alone (29.3%), aspiration plus stent retriever (19%), stent retriever alone (12.5%), balloon/catheter maceration (6.6%), and AngioJet rheolytic system (32.6%). Random-effects model indicated that 37% of patients had complete recanalization and 57% had partial recanalization. The model indicated that 79% of patients had a good clinical outcome (modified Rankin Scale score 0-2) at last follow-up. There were no statistically significant differences between modern systems (stent retriever and/or aspiration) and older systems (rheolytic thrombectomy and catheter maceration). Aspiration alone yielded a significantly higher frequency of good clinical outcomes compared with the combined technique (83.8% vs. 61.5%, p = 0.004).ConclusionEndovascular thrombectomy for CVST refractory to systemic anticoagulation achieved high recanalization rates, favorable outcomes, and low procedural complication rates. Modern and older techniques exhibited similar safety and efficacy. These findings support EVT as an effective treatment option.
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Affiliation(s)
- Diwas Gautam
- Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Omid Shoraka
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Sarah Nguyen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Michael T Bounajem
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Aaron Shoskes
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Jennifer Juhl Majersik
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Robert C Rennert
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Craig Kilburg
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Karol P Budohoski
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
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Bian HT, Wang X, Liu GY, Zhou C, Meng R, Liu L, Duan JG, Yan F, Li CH, Li M, Hui W, Zhang XX, Zhao D, Li YP, Fang Q, Kang DZ, Zeng HL, Liang ZJ, Shi ZH, Yue W, Sun QJ, Chen GS, Song JL, Yan ZR, Ji QH, Wang KJ, Tong LS, Hu X, Cao WF, Yan W, Gao RJ, Li Q, Wang JY, Liu Y, Wang BJ, Wang XH, Yao ST, Lang Y, Li HP, Anderson CS, Ji XM. Endovascular treatment for cerebral venous thrombosis: a multicenter study in China. Mil Med Res 2025; 12:16. [PMID: 40200369 PMCID: PMC11978133 DOI: 10.1186/s40779-025-00605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Accepted: 03/19/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND Endovascular treatment (EVT) is gaining popularity for the management of severe forms of cerebral venous thrombosis (CVT), but the evidence supporting its efficacy and safety is limited. METHODS This multicenter study included patients with CVT admitted to 104 hospitals in 31 provinces/cities in China between January 2018 and June 2022. Propensity score weighting models were used to adjust baseline confounding variables to determine the association of EVT on the primary outcome of good functional status, defined as score 0 - 1 on the modified Rankin Scale after hospital discharge. RESULTS Of 3063 patients identified through hospital records searches, 2774 adults [age (42 ± 15.8) years, female 50.3%] fulfilled eligibility criteria and agreed to be included, of whom 449 (16.2%) received EVT and 2325 (83.8%) received standard care. There was no significant difference between the EVT group and the standard care group in terms of the possibility of good functional recovery [weighted risk ratio = 1.00, 95% confidence interval (CI) 0.96 - 1.03]. Similarly, there was no difference in the likelihood of death at hospital discharge (weighted risk ratio = 1.91, 95% CI 0.91 - 3.68). In subgroup analysis, the possibility of good functional recovery was lower in patients with intracerebral hemorrhage (weighted risk ratio = 0.88, 95% CI 0.79 - 0.98; P for interaction = 0.01) and seizures (weighted risk ratio = 0.86, 95% CI 0.76 - 0.95; P for interaction = 0.03). CONCLUSION In this large nationwide study, EVT was not associated with improved functional outcomes compared to standard care in patients with CVT.
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Affiliation(s)
- He-Tao Bian
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Xia Wang
- The George Institute for Global Health, University of New South Wales, Sydney, 2000, Australia
| | - Gui-You Liu
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Chen Zhou
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China
| | - Ran Meng
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Lan Liu
- School of Statistics, University of Minnesota at Twin Cities, Minneapolis, MN, 55455, USA
| | - Jian-Gang Duan
- Department of Emergency, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
| | - Feng Yan
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
| | - Chuan-Hui Li
- Department of Neurology and Stroke Center, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
| | - Min Li
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Wen Hui
- Department of Science and Technology, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xu-Xiang Zhang
- Department of Ophthalmology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Dong Zhao
- Department of Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100013, China
| | - Ya-Peng Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450002, China
| | - Qi Fang
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - De-Zhi Kang
- Department of Neurosurgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, China
| | - Hong-Liang Zeng
- Department of Neurology, Ganzhou People's Hospital, Ganzhou, 341000, Jiangxi, China
| | - Zhi-Jian Liang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Xining, 530021, China
| | - Zheng-Hao Shi
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, 300350, China
| | - Qin-Jian Sun
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Gui-Sheng Chen
- Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, 750001, China
| | - Jian-Long Song
- Department of Neurology, the First Affiliated Hospital of USTC, Hefei, 230001, China
| | - Zhong-Rui Yan
- Department of Neurology, Jining First People's Hospital, Jining, 272113, Shandong, China
| | - Qiu-Hong Ji
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, China
| | - Kai-Jie Wang
- Department of Neurology, Tangshan Gongren Hospital, Tangshan, 063099, Hebei, China
| | - Lu-Sha Tong
- Department of Neurology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Xiao Hu
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Wen-Feng Cao
- Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, 330006, China
| | - Wei Yan
- Department of Neurology, the First People's Hospital of Kashi, Kashi, 84000, Xinjiang, China
| | - Rui-Jiang Gao
- Department of Neurology, Inner Mongolia People's Hospital, Hohhot, 010010, China
| | - Qi Li
- Department of Neurology, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China
| | - Jian-Yi Wang
- Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yi Liu
- Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, 030012, China
| | - Bao-Jun Wang
- Department of Neurology, Baotou Central Hospital Inner Mongolia, Baotou, 014040, Inner Mongolia Autonomous Region, China
| | - Xiao-Hua Wang
- Department of Neurology, Qujing No. 1 Hospital, Qujing, 655000, Yunnan, China
| | - Sheng-Tao Yao
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563099, Guizhou, China
| | - Ye Lang
- Department of Neurology, Shengli Oilfield Central Hospital, Dongying, 257100, Shandong, China
| | - Hai-Peng Li
- Department of Neurology, the First People's Hospital of Chenzhou, Chenzhou, 424300, Hunan, China
| | - Craig S Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, 2000, Australia
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, 200433, China
| | - Xun-Ming Ji
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, 100069, China.
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China.
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Morel B, Hoffman J, Roark C, Folzenlogen Z, Seinfeld J, Case D. Endovascular treatment of cerebral venous thrombosis involving the deep venous system. Interv Neuroradiol 2025:15910199251330723. [PMID: 40152202 PMCID: PMC11954136 DOI: 10.1177/15910199251330723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 03/03/2025] [Indexed: 03/29/2025] Open
Abstract
BackgroundCerebral venous thrombosis (CVT) is a rare but important cause of stroke. The superficial venous sinuses, including the superior sagittal sinus, are the most common location of CVT. Thrombosis of the deep venous system occurs less frequently, but can be more clinically severe by causing disturbances of consciousness due to involvement of deep anatomic structures including the thalamus and basal ganglia, leading to a higher incidence of death and disability. While anticoagulation is the standard initial recommended therapy for patients with CVT, endovascular intervention is sometimes proposed to help relieve cerebral venous hypertension.MethodsWe performed a retrospective case series review of a single-center interventional database over a 13-year time period to identify cases of CVT that underwent endovascular therapy and analyzed clinical and radiographic characteristics of these patients.ResultsWe identified 43 patients who underwent endovascular treatment for CVT. Twelve of these cases involved the deep system. Of the 12 patients in our consecutive case series, all 12 experienced recanalization of the deep system following catheter-directed alteplase infusions in the superficial or straight sinuses. On follow-up, these patients clinically did well in spite of initially poor neurologic examinations.ConclusionIn this single-center retrospective case series of 12 patients with deep and superficial venous thrombosis, endovascular treatment with site-directed thrombolytic infusion of the superficial venous sinuses with or without catheterization of the straight sinus resulted in angiographic recanalization of the deep veins and improved radiologic and clinical outcomes in 100% of the patients.
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Affiliation(s)
- Brent Morel
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jessa Hoffman
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christopher Roark
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Zach Folzenlogen
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joshua Seinfeld
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - David Case
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, USA
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Leng S, Li W, Cai Y, Zhang Y. The endovascular treatment strategies of cerebrovascular injuries in traumatic brain injury. Chin J Traumatol 2025; 28:81-90. [PMID: 39934036 PMCID: PMC11973697 DOI: 10.1016/j.cjtee.2025.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Revised: 01/11/2025] [Accepted: 01/12/2025] [Indexed: 02/13/2025] Open
Abstract
Vasculature injury occurs rarely in traumatic brain injury but increases lifetime risk of ischemic or hemorrhage stroke. The diverse and nonspecific clinical manifestations make the diagnosis and treatment of these injuries highly challenging. With advancements in device design, endovascular treatments have become widely adopted, playing an increasingly vital role in the management of vascular diseases. The purpose of this review is to introduce and summarize endovascular treatments of traumatic cerebrovascular injury and other related pathological states after traumatic brain injury. Given the innovations of neuroendovascular devices and improvements in the techniques over the past decade, this review will outline several recent advancements in endovascular treatment strategies for cerebrovascular pathologies. Popularizing more treatment options to clinicians will benefit in dealing with a variety of clinical scenarios and reduce the overall morbidity of traumatic cerebrovascular injury.
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Affiliation(s)
- Shuo Leng
- Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210009, China
| | - Wentao Li
- Department of Radiology, Medical School, Southeast University, Nanjing, 210009, China
| | - Yu Cai
- Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210009, China
| | - Yi Zhang
- Center of Interventional Radiology & Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210009, China.
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Li M, Song B, Wu Y, Zhang Y, Cao X, Zhang H, Xu Y, Wu C, Li C, Zhou C, Liu L, Yan F, Li S, Chen J, Meng R, Duan J, Wu D, Zuo L, Xu Z, Li Z, Zheng Y, Jiang M, Ji X. Dumbbell-shaped thrombectomy device for cerebral venous sinus thrombus removal with controllable axial and longitudinal maneuverability. Natl Sci Rev 2025; 12:nwaf015. [PMID: 39958147 PMCID: PMC11827591 DOI: 10.1093/nsr/nwaf015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 11/17/2024] [Accepted: 01/12/2025] [Indexed: 02/18/2025] Open
Abstract
Cerebral venous sinus thrombosis (CVST) is frequently observed in younger adults and features in large thrombus volume. Due to the triangular-like cross-sectional shape and large diameter of the superior sagittal sinus, all the commercially available artery stent retrievers are not suitable for venous vessels. In this study, a dumbbell-like stent was designed and fabricated by 3D braided technology using NiTi wires; it was manually rotatable and stretchable with controlled length/diameter ratios (2.6-14.0) and reciprocating maneuverability. Computational modeling and an in vitro study were conducted to evaluate the mechanical properties of this device and its ability to trap and remove thrombi from occluded venous vessels was verified by using a swine model. A single-center retrospective clinical study of 10 patients using the Venus-TD to treat patients with CVST was also conducted. Pre/postoperative thrombus volume in 10 patients was quantitatively analysed (12 855.3 ± 6417.1 vs. 2373.1 ± 2759.0 mm³, P < 0.001) with a high recanalization rate, yielding favorable clinical outcomes. This study offers a novel treatment option for patients with extensive CVST.
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Affiliation(s)
- Ming Li
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Baoying Song
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yan Wu
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Yang Zhang
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Xiaofeng Cao
- School of Materials Science and Engineering, Peking University, Beijing 100871, China
| | - Hongkang Zhang
- School of Materials Science and Engineering, Peking University, Beijing 100871, China
| | - Yi Xu
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chuanjie Wu
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chuanhui Li
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Chen Zhou
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Lu Liu
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Feng Yan
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Sijie Li
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jian Chen
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Ran Meng
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Jiangang Duan
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Di Wu
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Lin Zuo
- School of Bioengineering, Beihang University, Beijing 100191, China
| | - Zikai Xu
- School of Life Science, University of Glasgow, Glasgow G12 8QQ, Scotland
| | - Zhou Li
- CAS Center for Excellence in Nanoscience, Beijing Key Laboratory of Micro-Nano Energy and Sensor, Beijing Institute of Nanoenergy and Nanosystems, Chinese Academy of Sciences, Beijing 100083, China
- Tsinghua Changgung Hospital, School of Clinical Medicine, School of Biomedical Engineering, Tsinghua Medicine, Tsinghua University, Beijing 100084, China
| | - Yufeng Zheng
- School of Materials Science and Engineering, Peking University, Beijing 100871, China
| | - Miaowen Jiang
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China
| | - Xunming Ji
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Department of Neurosurgery and Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing 100069, China
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Döring K, Ratuszny D, Schuppner R, Giesemann A, Bültmann E, Lanfermann H, Abu-Fares O. Successful venous thrombectomy for extensive cerebral venous and sinus thrombosis after failed diagnostic lumbar puncture. ROFO-FORTSCHR RONTG 2025. [PMID: 39775573 DOI: 10.1055/a-2487-1371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
With an incidence of 2-5 per million adults, cerebral venous and sinus thrombosis (CVST) is a rarity in the spectrum of cerebrovascular diseases. The etiology and symptomatic presentation are heterogeneous and diverse. CSVT is, therefore, often underdiagnosed. In addition to therapeutic anticoagulation, venous thrombectomy is a last-resort therapy in individual cases.A 42-year-old woman was admitted to the hospital with postural headache following an unsuccessful lumbar puncture. On suspicion of post-puncture syndrome, analgesic therapy with adjuvant caffeine tablets was initially chosen, leading to rapid improvement and short-term discharge. However, only one day later, the patient presented with a significant worsening of her symptoms and new onset of paresthesia. Since distally accentuated paresis of the left arm also occurred within a very short period of time, a cerebral MRI examination was performed. This revealed an extensive CVST. Due to the extensive CVST and progressive worsening of symptoms, mechanical venous thrombectomy was discussed and performed on an interdisciplinary basis. Mechanical thrombectomy was successful and resulted in complete improvement of symptoms.The pathophysiological diagnosis is cerebrospinal fluid leak syndrome after unsuccessful lumbar puncture. According to the Monroe-Kellie doctrine, the loss of CSF leads to compensatory dilatation and venous stasis, which in combination can lead to venous insufficiency and promote prothrombotic conditions. Although the available data on the performance of venous thrombectomy suggest caution, there should always be sufficient discretion for individual decision making. As our experience shows, there is a chance of successful venous thrombectomy in the early phase of CVST. · CVST is a rarity in the spectrum of cerebrovascular diseases.. · The etiology and symptomatic presentation are heterogeneous and diverse.. · A rare cause is the loss of CSF.. · Mechanical venous thrombectomy is a possible treatment option.. · Döring K, Ratuszny D, Schuppner R et al. Successful venous thrombectomy for extensive cerebral venous and sinus thrombosis after failed diagnostic lumbar puncture. Fortschr Röntgenstr 2024; DOI 10.1055/a-2487-1371.
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Affiliation(s)
- Katja Döring
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | | | - Ramona Schuppner
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Anja Giesemann
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Eva Bültmann
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Heinrich Lanfermann
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Omar Abu-Fares
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
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8
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Xu Y, Wu Y, Jiang M, Song B, Li C, Wu C, Duan J, Meng R, Zhou C, Li S, Yan F, Chen J, Li M, Ji X. Efficacy and Safety of a Dedicated Device for Cerebral Venous Thrombectomy: A Pilot Randomized Clinical Trial. Stroke 2025; 56:5-13. [PMID: 39601121 DOI: 10.1161/strokeaha.124.045607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 08/26/2024] [Accepted: 10/29/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Lack of a dedicated thrombectomy device for cerebral venous thrombosis hinders the recanalization ability of endovascular treatment (EVT). Novel NiTi-braided stent retriever (Venous-TD) is a dedicated venous sinus thrombectomy device. This study aims to demonstrate the safety and efficacy of Venous-TD. METHODS In this pilot, prospective, randomized, single-blind, parallel-group control, single-center clinical study, patients with cerebral venous thrombosis from Beijing Xuanwu Hospital were included. Randomization was performed to EVT with either the Venous-TD or Angioguard with Sterling balloon (control group). The primary efficacy outcome was the proportion of immediate complete recanalization during EVT. Secondary outcomes included the proportion of functional independence and moderate to severe residential headache at 180 days after EVT. Safety outcomes included peri-procedural complications, all-cause mortality, and symptomatic intracranial hemorrhage after EVT. RESULTS A total of 61 patients were enrolled and randomized. Thirty-one patients were randomized to the Venous-TD group, and 30 were randomized to the control group. The median (interquartile range) age was 28 (21-45) in the Venous-TD group and 34 (24-43) in the control group. The proportion of patients with a National Institutes of Health Stroke Scale score >8 on admission was 8 (25.8%) in the Venous-TD group and 11 (36.7%) in the control group. During EVT, Venous-TD significantly improved the proportion of complete recanalization compared with Angioguard (23 [76.7%] versus 6 [20.0%]; relative risk, 3.833 [95% CI, 1.825-8.054]). The proportions of long-term functional independence at 180 days in the Venous-TD group and the control group were not significantly different. The proportion of patients with severe residual headache at 180 days in the Venous-TD group was significantly lower than that in the control group (3 [9.7%] versus 10 [35.7%]; relative risk, 0.271 [95% CI, 0.083-0.886]). Safety outcomes showed no statistically significant difference between the 2 groups. CONCLUSIONS This trial indicated that Venous-TD did not increase complications in EVT of cerebral venous thrombosis and can significantly increase the proportion of complete recanalization. A multicenter phase III randomized control trial assessing efficacy and safety of Venous-TD is warranted. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05291585.
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Affiliation(s)
- Yi Xu
- Department of Neurosurgery and Neurology (Y.X., B.S., C.L., C.W., J.D., R.M., F.Y., J.C., X.J.), Xuanwu Hospital, Capital Medical University
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics (Y.X., Y.W., S.L., M.L., X.J.), Xuanwu Hospital, Capital Medical University
| | - Yan Wu
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics (Y.X., Y.W., S.L., M.L., X.J.), Xuanwu Hospital, Capital Medical University
- Emergency Department (Y.W., J.D., S.L.), Xuanwu Hospital, Capital Medical University
| | - Miaowen Jiang
- Beijing Institute for Brain Disorders, Capital Medical University, China (M.J., C.Z., X.J.)
| | - Baoying Song
- Department of Neurosurgery and Neurology (Y.X., B.S., C.L., C.W., J.D., R.M., F.Y., J.C., X.J.), Xuanwu Hospital, Capital Medical University
| | - Chuanhui Li
- Department of Neurosurgery and Neurology (Y.X., B.S., C.L., C.W., J.D., R.M., F.Y., J.C., X.J.), Xuanwu Hospital, Capital Medical University
| | - Chuanjie Wu
- Department of Neurosurgery and Neurology (Y.X., B.S., C.L., C.W., J.D., R.M., F.Y., J.C., X.J.), Xuanwu Hospital, Capital Medical University
| | - Jiangang Duan
- Department of Neurosurgery and Neurology (Y.X., B.S., C.L., C.W., J.D., R.M., F.Y., J.C., X.J.), Xuanwu Hospital, Capital Medical University
- Emergency Department (Y.W., J.D., S.L.), Xuanwu Hospital, Capital Medical University
| | - Ran Meng
- Department of Neurosurgery and Neurology (Y.X., B.S., C.L., C.W., J.D., R.M., F.Y., J.C., X.J.), Xuanwu Hospital, Capital Medical University
| | - Chen Zhou
- Beijing Institute for Brain Disorders, Capital Medical University, China (M.J., C.Z., X.J.)
| | - Sijie Li
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics (Y.X., Y.W., S.L., M.L., X.J.), Xuanwu Hospital, Capital Medical University
- Emergency Department (Y.W., J.D., S.L.), Xuanwu Hospital, Capital Medical University
| | - Feng Yan
- Department of Neurosurgery and Neurology (Y.X., B.S., C.L., C.W., J.D., R.M., F.Y., J.C., X.J.), Xuanwu Hospital, Capital Medical University
| | - Jian Chen
- Department of Neurosurgery and Neurology (Y.X., B.S., C.L., C.W., J.D., R.M., F.Y., J.C., X.J.), Xuanwu Hospital, Capital Medical University
| | - Ming Li
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics (Y.X., Y.W., S.L., M.L., X.J.), Xuanwu Hospital, Capital Medical University
| | - Xunming Ji
- Department of Neurosurgery and Neurology (Y.X., B.S., C.L., C.W., J.D., R.M., F.Y., J.C., X.J.), Xuanwu Hospital, Capital Medical University
- China-America Institute of Neuroscience and Beijing Institute of Geriatrics (Y.X., Y.W., S.L., M.L., X.J.), Xuanwu Hospital, Capital Medical University
- Beijing Institute for Brain Disorders, Capital Medical University, China (M.J., C.Z., X.J.)
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9
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Yardibi F, Demirci S. Global trends and hot spots in cerebral venous sinus thrombosis research over the past 50 years: a bibliometric analysis. Neurol Res 2025; 47:23-34. [PMID: 39603272 DOI: 10.1080/01616412.2024.2430999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Accepted: 11/13/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) is an uncommon form of cerebrovascular disease. Although our understanding of CVST has improved significantly over the past decades, there has been no bibliometric analysis of CVST until now. We aimed to examine and visualize the hotspots and trends of the research related to CVST using a bibliometric analysis based on Citespace and provide new insights for scholars in their future researches in this area. METHODS The literature on CVST was collected from the Web of Science Core Collection database. Bibliometric analysis was performed using CiteSpace (6.2.R3) Advanced software. RESULTS A total of 2396 articles were included in the analysis. Publications regarding CVST have increased over time. U.S.A. contributed the most articles. Ferro JM had the highest number of published papers. Stroke was the journal with the most publications and the most commonly cited journal. Nine out of the top 10 cited journals belong to Q1. The risk factors for CVST, emerging and current treatment of CVST, and CVST related to COVID-19 and COVID-19 vaccines are the major potential research hot spots and trends. CONCLUSIONS CVST is a rapidly expanding research area and has received increasing attention by the researchers. Our study can provide researchers valuable information on the current status and trends in this area and guide for future studies.
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Affiliation(s)
- Fatma Yardibi
- Faculty of Communication, Department of New Media and Communication, Akdeniz University, Antalya, Turkey
| | - Seden Demirci
- School of Medicine, Department of Neurology, Akdeniz University, Antalya, Turkey
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10
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Dix C, Hunt BJ. The changing face of cerebral venous sinus thrombosis-emerging new causes and treatments. J Thromb Haemost 2024; 22:3346-3354. [PMID: 39260741 DOI: 10.1016/j.jtha.2024.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/21/2024] [Accepted: 08/26/2024] [Indexed: 09/13/2024]
Abstract
Cerebral venous sinus thrombosis (CVST) is an uncommon site of venous thromboembolism. CVST more commonly affects younger people and women, in stark contrast to other forms of venous thrombosis in which incidence increases with age and overall affects men. Traditional risk factors for the development of CVST include endogenous and exogenous estrogen (combined oral contraceptives and pregnancy and the puerperium), thrombophilias, and rare hematologic disorders. New and emerging risk factors include obesity, polycystic ovary syndrome, COVID-19 infection, and vaccine-induced thrombocytopenia and thrombosis and vaccine-induced thrombocytopenia and thrombosis-like disorders. Management centers around anticoagulation, management of the underlying cause, and consideration of invasive measures including endovascular thrombolysis and/or thrombectomy and craniectomy for severe cases. This review discusses the emerging risk factors and their identification, evidence for treatment including the use of direct oral anticoagulants, and the role of invasive management options.
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Affiliation(s)
- Caroline Dix
- Department of Clinical Haematology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Clinical Haematology, Austin Hospital, Heidelberg, Victoria, Australia.
| | - Beverley J Hunt
- Thrombosis and Haemophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom. https://twitter.com/bhwords
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11
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Greenberg G, Steinberg DM, Salomon O. Sinus vein thrombosis conundrum: Persistent empty sella vs. flexible optic nerve sheath. J Neurol Sci 2024; 466:123274. [PMID: 39433010 DOI: 10.1016/j.jns.2024.123274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 09/29/2024] [Accepted: 10/13/2024] [Indexed: 10/23/2024]
Abstract
INTRODUCTION Our objective was to investigate the potential effect of thrombotic burden on pituitary gland height, bony sella and optic sheath width, taking into consideration the various venous sites and dominant drainage pattern. PATIENTS AND METHODS This retrospective cohort study followed patients diagnosed with cerebral sinus vein thrombosis in a single primary healthcare center between the years 2000 and 2022. Data was collected from both CT/V and MR/V scans available on the local PACS system. Dural sinuses were divided into main anatomical sites and scored for patent, partially or totally blocked lumen. Dominant drainage flow was noted for each patient. For most scans, pituitary mid height, maximal depth and AP width of the bony sella and dorsum sella to tuberculum sella distance were assessed. Optic sheath width was measured for both sides at the maximal retrobulbar diameter. Regression methods, including linear mixed models, and non-parametric tests were used to analyze the data. RESULTS 90 patients (mean age, 44 years ±16.8, 54 women) were evaluated. Overall thrombus burden did not correlate with pituitary mid-height, however a relationship was observed between the change (from presentation) in the superficial thrombus score and the average width of the optic nerve sheath; the width of the optic sheath tended to decrease as thrombus burden improved and vice versa (p = 0.010). CONCLUSIONS Thrombus recanalization had a favorable effect on the optic nerve sheath diameter but did not appear to reverse the flattening of the pituitary gland, regardless of temporal improvement.
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Affiliation(s)
- Gahl Greenberg
- Department of Diagnostic Imaging, Neuroradiology section, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. Affiliated with Tel Aviv University, Faculty of Medical and Health Sciences, Tel Aviv, Israel.
| | - David M Steinberg
- Department of Statistics and Operations Research, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Ophira Salomon
- Thrombosis and Hemostasis Institute, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel. Affiliated with Tel Aviv University, Faculty of Medical and Health Sciences, Tel Aviv, Israel.
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12
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Chang YZ, Song YQ, Zhu HY, Zhang JR, Fu XG, Wang YL, Dong KH, Jiang CH, Mo DP, Zhang YP. Enhanced T-cell activation and chemokine-associated function in CD14-positive cells from venous sinus blood in sub-acute cerebral venous sinus thrombosis. Front Cell Dev Biol 2024; 12:1488005. [PMID: 39605979 PMCID: PMC11599252 DOI: 10.3389/fcell.2024.1488005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 10/23/2024] [Indexed: 11/29/2024] Open
Abstract
Background Patients with sub-acute cerebral venous sinus thrombosis experience (SA.CVST) severe symptoms compared to two other venous sinus-related diseases, including chronic cerebral venous sinus thrombosis (C.CVST) and idiopathic intracranial hypertension (IIH). Objective This study aimed to determine whether the different immune reactions in different venous sinuses are related. Methods Stagnant blood in the cerebral venous sinuses was extracted by passing a microcatheter and CD14-positive cells were sorted by magnetic beads and subjected to RNA-seq sequencing. Results Compared to patients with IIH, 128 genes were significantly down-regulated and 373 genes were significantly up-regulated in the sub-acute CVST samples. The functions of these genes were mainly focused on "immune response", "T cell activation" and "plasma membrane". Gene Set Enrichment Analysis (GSEA) showed T cell survival and activation-related function significantly unregulated in sub-acute CVST. On the other hand, there were 366 genes down-regulated in chronic CVST and 75 genes up-regulated in chronic CVST. In functional annotation, these differently expressed genes were enriched in the "extracellular region", "chemokine-mediated signaling pathway" and "immune response". GSEA analysis confirmed that chemokine-related functions were all up-regulated in sub-acute CVST and monocyte-macrophage adhesion functions were also significantly up-regulated. Conclusion This study suggested the CD14-positive created an activated immune response in sub-acute CVST.
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Affiliation(s)
- Yu-Zhou Chang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu-Qi Song
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao-Yu Zhu
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jia-Rui Zhang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xi-Guang Fu
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ke-Hui Dong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chu-Han Jiang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Da-Peng Mo
- Interventional Neuroradiology Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu-Peng Zhang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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13
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Paybast S, Mohamadian R, Emami A, Jameie M, Shahrab F, Zamani F, Sharifipour E. Safety and efficacy of endovascular thrombolysis in patients with acute cerebral venous sinus thrombosis: A systematic review. Interv Neuroradiol 2024; 30:746-758. [PMID: 36471504 PMCID: PMC11569481 DOI: 10.1177/15910199221143418] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/13/2022] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Cerebral venous sinus thrombosis (CVST) is an uncommon but fatal cause of stroke worldwide. Endovascular treatments could be life-saving in patients who don't treat with anticoagulants as a mainstay of treatment. Currently, there is no consensus considering the safety, efficacy, and also selected approaches of endovascular intervention for these patients. This systematic review evaluates the literature on endovascular thrombolysis (EVT) in CVST patients. MATERIALS AND METHODS A comprehensive search was conducted through PubMed and Scopus databases between 2010 and 2021, with additional sources identified through cross-referencing. The primary outcomes were the safety and efficacy of EVT in CVST, including catheter-related and non-catheter-related complications, clinical outcomes, and radiological outcomes. RESULTS A total of 10 studies comprising 339 patients were included. Most of the patients presented with headaches (86.72%) and/or focal neurologic deficits (45.43%) (modified Rankin Scale of 5 in 55.88%). Acquired coagulopathy and/or consuming estrogen/progesterone medication were the most frequent predisposing factors (45.59%). At presentation, 68.84% had multi-sinus involvement, and 28.90% had venous infarcts and/or intracranial hemorrhage (ICH). The overall complication rate was 10.3%, with a 2.94%, 1.47%, and 1.17% rate of ICH, herniation, and intracranial edema, respectively. The complete and partial postoperative radiographic resolution was reported in 89.97% of patients, increasing to 95.21% during the follow-up. Additionally, 72.22% of patients had no or mild neurologic deficit at discharge, rising to 91.18% at the last follow-up. The overall mortality rate was 7.07%. CONCLUSIONS EVT can be an effective and safe treatment option for patients with refractory CVST or contraindications to systemic anticoagulation.
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Affiliation(s)
- Sepideh Paybast
- Neurology Department and Stroke Unit, Shohada-Tajrish Tertiary University Hospital, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Mohamadian
- Radiology Department, Eastern Clinical University Hospital, Stradins University, Riga, Latvia
| | - Ali Emami
- Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Melika Jameie
- Neurology Department and Stroke Unit, Shohada-Tajrish Tertiary University Hospital, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereshteh Shahrab
- Neuroscience Research Center of Qom University of Medical Sciences, Qom, Iran
| | - Farideh Zamani
- Neuroscience Research Center of Qom University of Medical Sciences, Qom, Iran
| | - Ehsan Sharifipour
- Neurology Department and Stroke Unit, Shohada-Tajrish Tertiary University Hospital, Shahid-Beheshti University of Medical Sciences, Tehran, Iran
- Neuroscience Research Center of Qom University of Medical Sciences, Qom, Iran
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14
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Nguyen VN, Demetriou AN, Dallas J, Mack WJ. Cerebral Venous Sinus Thrombosis. Neurosurg Clin N Am 2024; 35:343-353. [PMID: 38782527 DOI: 10.1016/j.nec.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Cerebral venous sinus thrombosis (CVST) is a rare type of stroke indicated by the formation of blood clots within the dural venous sinuses. These are large venous conduits that are situated between the 2 layers of the dura mater which are responsible for draining blood from the brain and returning it to the systemic circulation. Cortical venous thrombosis refers to the blockage of veins on the brain's cortical surface. Cerebral venous thrombosis encompasses both dural and cortical vein occlusions.
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Affiliation(s)
- Vincent N Nguyen
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA
| | - Alexandra N Demetriou
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA
| | - Jonathan Dallas
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA
| | - William J Mack
- Department of Neurosurgery, University of Southern California, 1520 San Pablo Street, Suite 3800, Los Angeles, CA 90033, USA.
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15
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Ghimire S, Shrestha S, Shrestha D, Ranabhat K, Bhattarai S, Maharjan A, Jaiswal B, Chaudhary P. Cerebral venous sinus thrombosis in patient of immune thrombocytopenic purpura managed with mechanical thrombectomy: An anecdotal endovascular experience from lower middle income country. Clin Case Rep 2024; 12:e8931. [PMID: 38827945 PMCID: PMC11142893 DOI: 10.1002/ccr3.8931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/14/2024] [Accepted: 04/29/2024] [Indexed: 06/05/2024] Open
Abstract
Cerebral venous sinus thrombosis in itself is rarely encountered clinical entity and its association with immune thrombocytopenic purpura (ITP) makes it more unusual presentation. No any as such standard guidelines exist that guides the prompt evidence based management in such concurrent cases but neuroendovascular modality can play a pivotal role.
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Affiliation(s)
- Sagun Ghimire
- Department of NeuroscienceB and B hospitalLalitpurNepal
| | | | | | | | | | | | - Bibek Jaiswal
- Department of NeuroscienceB and B hospitalLalitpurNepal
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16
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Quealy JB. Mechanical Thrombectomy for Aseptic, Atraumatic, Medically Refractory Cerebral Venous Sinus Thrombosis: a Systematic Review. Clin Neuroradiol 2024; 34:451-463. [PMID: 38329489 DOI: 10.1007/s00062-023-01373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/10/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) follows a severe clinical course in 13.5% of cases. Practice guidelines recommend endovascular therapy (EVT); no randomised control trials (RCTs) exist comparing EVTs. PURPOSE To determine whether specific EVTs are superior to alternatives. DATA SOURCES CENTRAL, Medline, Embase, five other databases and four clinical trials registers. Grey literature searches, reference checking, citation searching, and author contact. STUDY SELECTION All CVST cases treated with mechanical thrombectomy (MT) were includible. Paediatric, and trauma-related or infection-related thromboses were excluded. DATA ANALYSIS Standard Cochrane review procedures. Primary outcome measures; clinical efficacy (modified Rankin Score, mRS), technical efficacy (recanalisation), and clinical safety (procedure-related complications and death). Subgroup analyses were performed, comparing outcome measures between demographic groups, clinico-radiological severity, interventional strategies, and degrees of recanalisation. DATA SYNTHESIS In this study 124 papers were included (n = 486). All patients underwent MT, with 69.5% of patients receiving concomitant chemolysis. New/expanding intracerebral haemorrhage (ICH) occurred in 5.1%; non-haemorrhagic complications in 1.4%; 10.7% died. Predictors of poor efficacy included age ≥ 55 years, altered mental status (AMS), Glasgow Coma Scale (GCS) < 8. Predictive of poor safety outcomes included pre-existing ICH, deep system thrombosis, and AMS. Complete recanalisation was associated with improved clinical efficacy and safety outcomes. LIMITATIONS The review is based on case reports/series, increasing bias-risk. Myriad of potentially includible studies were necessarily excluded due to lack of requisite details. CONCLUSION Predictors of poor outcomes with medical therapy predict poor outcomes with MT; these measures should not dictate candidacy. Complete recanalisation predicts favorable clinical and safety outcomes. Local chemolysis is safe, improves recanalisation, and should be recommended, provided there is no contraindication. Clot maceration strategies and stent-retriever thrombectomy are associated with superior clinical efficacy and safety endpoints, as compared with balloon angioplasty and rheolysis.
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Affiliation(s)
- John B Quealy
- Department of Internal Medicine, UPMC Aut Even Hospital, Freshford Road, R95D370, Kilkenny, Ireland.
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17
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Sousa JA, Achutegui MI, Juega-Mariño J, Requena M, Bernardo-Castro S, Rodrigo-Gisbert M, Rizzo F, Olivé M, Garcia-Tornel Á, Chaves AC, Rodriguez-Villatoro N, Muchada M, Pagola J, Rodriguez-Luna D, Rubiera M, Martins AI, Silva F, Veiga R, Nunes C, Machado E, Diana F, de Dios M, Hernández D, Ribo M, Molina C, Sargento-Freitas J, Tomasello A. Acute management of cerebral venous thrombosis: Indications, technique, and outcome of endovascular treatment in two high-volume centers. Interv Neuroradiol 2024:15910199241236819. [PMID: 38556254 PMCID: PMC11569797 DOI: 10.1177/15910199241236819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/15/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION After several uncontrolled studies and one randomized clinical trial, there is still uncertainty regarding the role of endovascular treatment (EVT) in cerebral venous thrombosis (CVT). This study aims to describe and assess different acute management strategies in the treatment of CVT. METHODS We performed a retrospective analysis of an international two-center registry of CVT patients admitted since 2019. Good outcome was defined as a return to baseline modified Rankin scale at three months. We described and compared EVT versus no-EVT patients. RESULTS We included 61 patients. Only one did not receive systemic anticoagulation. EVT was performed in 13/61 (20%) of the cases, with a median time from diagnosis to puncture of 4.5 h (1.25-28.5). EVT patients had a higher median baseline NIHSS [6 (IQR 2-17) vs 0 (0-2.7), p = 0.002)] and a higher incidence of intracerebral hemorrhage (53.8% vs 20.3%, p = 0.03). Recanalization was achieved in 10/13 (77%) patients. Thrombectomy was performed in every case with angioplasty in 7 out of 12 patients and stenting in 3 cases. No postprocedural complication was reported. An improvement of the median NIHSS from baseline to discharge [6 (2-17) vs 1(0-3.75); p < 0.001] was observed in EVT group. A total of 31/60 patients (50.8%) had good outcomes. Adjusting to NIHSS and ICH, EVT had a non-significant increase in the odds of a good outcome [aOR 1.42 (95%CI 0.73-2.8, p = 0.307)]. CONCLUSIONS EVT in combination with anticoagulation was safe in acute treatment of CVT as suggested by NIHSS improvement. Selected patients may benefit from this treatment.
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Affiliation(s)
- João André Sousa
- Stroke Unit, Department of Neurology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Maider Iza Achutegui
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Jesus Juega-Mariño
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Sara Bernardo-Castro
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Marc Rodrigo-Gisbert
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Federica Rizzo
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Marta Olivé
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Álvaro Garcia-Tornel
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Ana Carolina Chaves
- Department of Neuroradiology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | | | - Marian Muchada
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Jorge Pagola
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - David Rodriguez-Luna
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Marta Rubiera
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Ana Inês Martins
- Stroke Unit, Department of Neurology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Fernando Silva
- Stroke Unit, Department of Neurology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Ricardo Veiga
- Department of Neuroradiology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Cesar Nunes
- Department of Neuroradiology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Egídio Machado
- Department of Neuroradiology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Francesco Diana
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Marta de Dios
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - David Hernández
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Marc Ribo
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - Carlos Molina
- Stroke Unit, Department of Neurology, Hospital Universitari Vall dHebron, Barcelona, Spain
| | - João Sargento-Freitas
- Stroke Unit, Department of Neurology, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Alejandro Tomasello
- Department of Interventional Neuroradiology, Hospital Universitari Vall dHebron, Barcelona, Spain
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18
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Batista S, Sanches JPB, Andreão FF, Porto Sousa M, Oliveira LDB, Yuri Ferreira M, Bertani R, Alves Filho CAF, de Oliveira Braga F, Machado EAT, da Mata Pereira PJ, Niemeyer Filho P, Almeida Filho JA. Evaluating the efficacy of stent retriever and catheter aspiration combination in refractory cerebral venous sinus Thrombosis: A comprehensive Meta-Analysis. J Clin Neurosci 2024; 120:154-162. [PMID: 38244530 DOI: 10.1016/j.jocn.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Cerebral Venous Sinus Thrombosis (CVST) is a rare but potentially life-threatening condition, often associated with specific risk factors. The primary treatment for CVST is anticoagulation, but some cases progress to Refractory CVST (rCVST), requiring endovascular treatment. A combination of stent retriever and catheter aspiration is emerging as a promising technique to enhance treatment effectiveness. We conducted a systematic review and meta-analysis to assess the safety and efficacy of this approach, aiming to improve recanalization success and neurological outcomes while reducing complications in rCVST patients. METHODS A search following PRISMA guidelines was conducted across Pubmed, Embase, Web of Science, and Cochrane databases to identify studies on the use of stent retrievers and catheter aspiration for rCVST. Pooled analysis with 95 % confidence intervals was used to assess the effects. Heterogeneity was evaluated using I2 statistics and a random-effects model was used. Complete recanalization. good clinical outcomes (mRS ≤ 2), hemorrhagic, neurological, ischemic, and total complications, poor clinical outcomes (mRS > 2), and mortality were assessed. RESULTS A meta-analysis of five retrospective studies involving 55 patients examined outcomes in CVST. The median mean age was 40 years. Complete recanalization rate: 36 % (95 % CI: 9 % to 62 %, I2 = 90 %). Good clinical outcomes: 72 % (95 % CI: 50 % to 94 %, I2 = 76 %). Hemorrhagic complications: 2 % (95 % CI: 0 % to 8 %, I2 = 15 %). Ischemic complications: 0 % (95 % CI: 0 % to 6 %, I2 = 0 %). Neurological complications: 7 % (95 % CI: 0 % to 14 %, I2 = 0 %). Poor clinical outcomes: 26 % (95 % CI: 6 % to 46 %, I2 = 70 %). Total complications: 6 % (95 % CI: 0 % to 15 %, I2 = 10 %). Mortality rate: 5 % (95 % CI: 0 % to 13 %, I2 = 19 %). CONCLUSION This systematic review and meta-analysis scrutinized the efficacy of combining Stent Retriever and Catheter Aspiration for rCVST. Findings highlighted varied outcomes, including recanalization rates, complications, and mortality. The dichotomy between good and poor outcomes underscores the necessity for personalized therapeutic decisions. While offering a comprehensive overview, the study emphasizes literature heterogeneity, suggesting a need for more rigorous and standardized research to optimize therapeutic strategies in clinical practice.
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Affiliation(s)
- Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Filipi Fim Andreão
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Faculty of Medicine, State University of Ponta Grossa, Ponta Grossa, PR, Brazil; Faculty of Medicine, Ninth July University - São Paulo, SP, Brazil; Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil; Department of Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, RJ, Brazil
| | - Marcelo Porto Sousa
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | | | - Paulo Niemeyer Filho
- Department of Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, RJ, Brazil
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Ranjan R, Ken-Dror G, Sharma P. Pathophysiology, diagnosis and management of cerebral venous thrombosis: A comprehensive review. Medicine (Baltimore) 2023; 102:e36366. [PMID: 38050259 PMCID: PMC10695550 DOI: 10.1097/md.0000000000036366] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023] Open
Abstract
Cerebral venous thrombosis is a rare cause of stroke in young mostly female adults which is frequently overlooked due to its variable clinical and radiological presentation. This review summarizes current knowledge on it risk factors, management and outcome in adults and highlights areas for future research. Females are 3 times more commonly affected and are significantly younger than males. The presenting symptoms can range from headache to loss of consciousness. However, the often-nebulous nature of symptoms can make the diagnosis challenging. Magnetic resonance imaging with venography is often the diagnostic imaging of choice. While unfractionated or low molecular-weight heparin is the mainstay of treatment, endovascular intervention with thrombolysis or thrombectomy and decompressive craniectomy may be required depending on clinical status. Nevertheless, approximately 80% of patients have a good recovery but mortality rates of -5% to 10% are not uncommon. Diagnosing cerebral venous thrombosis can be challenging but with vigilance and expert care patients have the best chance of a good clinical outcome.
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Affiliation(s)
- Redoy Ranjan
- Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham Hill, Greater London, United Kingdom
| | - Gie Ken-Dror
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham Hill, Greater London, United Kingdom
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham Hill, Greater London, United Kingdom
- Department of Clinical Neurology, Imperial College London Healthcare NHS Trust, London, United Kingdom
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20
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Chang YZ, Zhu HY, Song YQ, Tong X, Li XQ, Wang YL, Dong KH, Jiang CH, Zhang YP, Mo DP. High-resolution magnetic resonance imaging-based radiomic features aid in selecting endovascular candidates among patients with cerebral venous sinus thrombosis. Thromb J 2023; 21:116. [PMID: 37950211 PMCID: PMC10636961 DOI: 10.1186/s12959-023-00558-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES Cerebral venous sinus thrombosis (CVST) can cause sinus obstruction and stenosis, with potentially fatal consequences. High-resolution magnetic resonance imaging (HRMRI) can diagnose CVST qualitatively, although quantitative screening methods are lacking for patients refractory to anticoagulation therapy and who may benefit from endovascular treatment (EVT). Thus, in this study, we used radiomic features (RFs) extracted from HRMRI to build machine learning models to predict response to drug therapy and determine the appropriateness of EVT. MATERIALS AND METHODS RFs were extracted from three-dimensional T1-weighted motion-sensitized driven equilibrium (MSDE), T2-weighted MSDE, T1-contrast, and T1-contrast MSDE sequences to build radiomic signatures and support vector machine (SVM) models for predicting the efficacy of standard drug therapy and the necessity of EVT. RESULTS We retrospectively included 53 patients with CVST in a prospective cohort study, among whom 14 underwent EVT after standard drug therapy failed. Thirteen RFs were selected to construct the RF signature and CVST-SVM models. In the validation dataset, the sensitivity, specificity, and area under the curve performance for the RF signature model were 0.833, 0.937, and 0.977, respectively. The radiomic score was correlated with days from symptom onset, history of dyslipidemia, smoking, fibrin degradation product, and D-dimer levels. The sensitivity, specificity, and area under the curve for the CVST-SVM model in the validation set were 0.917, 0.969, and 0.992, respectively. CONCLUSIONS The CVST-SVM model trained with RFs extracted from HRMRI outperformed the RF signature model and could aid physicians in predicting patient responses to drug treatment and identifying those who may require EVT.
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Affiliation(s)
- Yu-Zhou Chang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Beijing, Fengtai District, 100070, P.R. China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao-Yu Zhu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Beijing, Fengtai District, 100070, P.R. China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu-Qi Song
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Beijing, Fengtai District, 100070, P.R. China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu Tong
- Interventional Neuroradiology Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Qing Li
- Interventional Neuroradiology Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ke-Hui Dong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chu-Han Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Beijing, Fengtai District, 100070, P.R. China.
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Yu-Peng Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Beijing, Fengtai District, 100070, P.R. China.
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Da-Peng Mo
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Beijing, Fengtai District, 100070, P.R. China.
- Interventional Neuroradiology Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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21
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Zhang R, sun D, Chen X, Xie Y, Dan B, Liu Y, Mei B, Li H. Successful hybrid endovascular treatment for refractory cerebral venous sinus thrombosis in pregnancy: A case report. Heliyon 2023; 9:e22262. [PMID: 38045129 PMCID: PMC10692894 DOI: 10.1016/j.heliyon.2023.e22262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Cerebral venous sinus thrombosis (CVST) in pregnancy was common and endovascular treatment (EVT) could be an effective and safe treatment for patients with severe and refractory CVST. However, the efficacy and safety of hybrid EVT (craniotomy + endovascular treatment) for CVST were unknown. We represented a rare case of hybrid EVT through the incision of the superior sagittal sinus in a pregnant woman with CVST who failed to EVT through the femoral vein pathway. CASE PRESENTATION A 26-year-old woman, in her second month of pregnancy, complained of a headache for 5 days and aggravation with coma combined with convulsions for 2 days. She was diagnosed with CVST in the local hospital by digital subtraction angiography (DSA) and treated with anticoagulation. She had no history of illness and the biochemical tests were normal. Hybrid EVT (craniotomy + EVT) was attempted after failing to conduct EVT through the femoral vein pathway due to difficulty to reach the target cerebral venous sinus. Briefly, a small hole was made in the frontotemporal head to expose the superior sagittal sinus and a 6F sheath was inserted into 2cm of superior sagittal sinus incision and fixed on the scalp, after repeated aspiration by 5F intermediate catheter and balloon dilatation of stenosis in the right transverse sinus and right sigmoid sinus, the cerebral venous system got successful recanalization. No obvious complications were found and the patient recovered very well after the surgery. CONCLUSION Anticoagulation was the standard treatment for CVST. EVT could rapidly restore venous flow and improve the prognosis for refractory and severe CVST. EVT by hybrid surgery through the superior sagittal sinus incision may be safe and effective for desperate patients with severe CVST.
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Affiliation(s)
- Renwei Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Dong sun
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinjun Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yu Xie
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bitang Dan
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yumin Liu
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bin Mei
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Huagang Li
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
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22
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Govind A, Kenchaiah R, Dubbal R, Gupta M, Meghana BK, Saravanan A, Kulanthaivelu K, Ramakrishnan S, Kulkarni GB. Mastoid fluid signal in acute cerebral venous thrombosis is is associated with increased clot burden. J Clin Neurosci 2023; 117:54-60. [PMID: 37769407 DOI: 10.1016/j.jocn.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/02/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
PURPOSE Mastoid air cell abnormalities in the form of hyperintense T2 fluid signal have been reported in cases of acute Cerebral Venous Thrombosis (CVT) without otologic infection and have been hypothesized to be a result of venous congestion rather than infectious mastoiditis. The aim of this study was to investigate a link between the spectrum of mastoid abnormalities and clot burden in patients with acute CVT. METHODS A retrospective study of adult patients admitted to the National Institute of Mental Health and Neurosciences between 2016 and 2023 who were diagnosed with acute CVT and had no clinical evidence of active or recent ear infections was conducted. Pre- and post-contrast MR Images were analyzed to identify the dural sinuses and/or cerebral veins involved and the presence of fluid signal in the mastoid. Fluid signal in the mastoid was graded from 0 to 3 as described by Shah et al- no fluid signal (grade 0), thin curvilinear hyperintensities (grade 1), thick crescenteric hyperintensities (grade 2), and complete hyperintensity (grade 3). Clot Burden Score (CBS) was calculated by assigning one point for each sinus involved, one point for extension of thrombus into the intracranial Internal Jugular Vein (IJV), one point for thrombosis of cortical veins and one point for thrombosis of deep cerebral veins. RESULTS A total of 89 patients with acute CVT were included in the final analysis. Median time from presentation to MRI was 2 days (range 0-13). 51 patients (57.3%) had fluid signal in the mastoid air cells on T2-weighted images, of whom 33 showed mucosal contrast enhancement. Higher grade of fluid signal in the mastoid was present ipsilateral to the side of venous thrombosis in 59 out of 60 patients with posterior fossa CVT. CBS was significantly different between patients with different grades of fluid signal (p = 0.002). Grade 2-3 fluid signal was associated with higher clot burden (CBS > 3) in both the entire study population (n = 89) - OR = 8.281, 95 %CI: 2.758-24.866 (p < 0.001) and among patients with posterior fossa CVT - OR = 4.375, 95 %CI: 1.320-14.504 (p = 0.016). Among patients with posterior fossa CVT, grade 2-3 fluid signal was associated with left sided transverse and/or sigmoid sinus thrombosis - OR = 5.600, 95 %CI: 1.413-22.188 (p = 0.014), and extension of thrombosis into the IJV - OR = 4.606, 95 %CI: 1.162-18.262 (p = 0.030). CONCLUSION T2 fluid signal in the mastoid is associated with venous congestion in adults with acute CVT without evidence of otologic infection. Moderate-to-severe T2 fluid signal in the mastoid air cells is associated with increased clot burden.
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Affiliation(s)
- Alok Govind
- Department of Neurology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - Raghavendra Kenchaiah
- Department of Neurology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - Rohin Dubbal
- Department of Neurology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - Manisha Gupta
- Department of Neurology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - B K Meghana
- Department of Neurology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - Akshaya Saravanan
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neruosciences, Bangalore, India
| | - Girish Baburao Kulkarni
- Department of Neurology, National Institute of Mental Health and Neruosciences, Bangalore, India.
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23
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Schirmer CM, Bulsara KR, Al-Mufti F, Haranhalli N, Thibault L, Hetts SW. Antiplatelets and antithrombotics in neurointerventional procedures: Guideline update. J Neurointerv Surg 2023; 15:1155-1162. [PMID: 37188504 DOI: 10.1136/jnis-2022-019844] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/22/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Antiplatelet and antithrombotic medication management before, during, and after neurointerventional procedures has significant practice variation. This document updates and builds upon the 2014 Society of NeuroInterventional Surgery (SNIS) Guideline 'Platelet function inhibitor and platelet function testing in neurointerventional procedures', providing updates based on the treatment of specific pathologies and for patients with specific comorbidities. METHODS We performed a structured literature review of studies that have become available since the 2014 SNIS Guideline. We graded the quality of the evidence. Recommendations were arrived at through a consensus conference of the authors, then with additional input from the full SNIS Standards and Guidelines Committee and the SNIS Board of Directors. RESULTS The management of antiplatelet and antithrombotic agents before, during, and after endovascular neurointerventional procedures continues to evolve. The following recommendations were agreed on. (1) It is reasonable to resume anticoagulation after a neurointerventional procedure or major bleeding episode as soon as the thrombotic risk exceeds the bleeding risk in an individual patient (Class I, Level C-EO). (2) Platelet testing can be useful to guide local practice, and specific approaches to using the numbers demonstrate marked local variability (Class IIa, Level B-NR). (3) For patients without comorbidities undergoing brain aneurysm treatment, there are no additional considerations for medication choice beyond the thrombotic risks of the catheterization procedure and aneurysm treatment devices (Class IIa, Level B-NR). (4) For patients undergoing neurointerventional brain aneurysm treatment who have had cardiac stents placed within the last 6-12 months, dual antiplatelet therapy (DAPT) is recommended (Class I, Level B-NR). (5) For patients being evaluated for neurointeventional brain aneurysm treatment who had venous thrombosis more than 3 months prior, discontinuation of oral anticoagulation (OAC) or vitamin K antagonists should be considered as weighed against the risk of delaying aneurysm treatment. For venous thrombosis less than 3 months in the past, delay of the neurointerventional procedure should be considered. If this is not possible, see atrial fibrillation recommendations (Class IIb, Level C-LD). (6) For patients with atrial fibrillation receiving OAC and in need of a neurointerventional procedure, the duration of TAT (triple antiplatelet/anticoagulation therapy=OAC plus DAPT) should be kept as short as possible or avoided in favor of OAC plus single antiplatelet therapy (SAPT) based on the individual's ischemic and bleeding risk profile (Class IIa, Level B-NR). (7) For patients with unruptured brain arteriovenous malformations there is no indication to change antiplatelet or anticoagulant management instituted for management of another disease (Class IIb, Level C-LD). (8) Patients with symptomatic intracranial atherosclerotic disease (ICAD) should continue DAPT following neurointerventional treatment for secondary stroke prevention (Class IIa, Level B-NR). (9) Following neurointerventional treatment for ICAD, DAPT should be continued for at least 3 months. In the absence of new stroke or transient ischemic attack symptoms, reversion to SAPT can be considered based on an individual patient's risk of hemorrhage versus ischemia (Class IIb, Level C-LD). (10) Patients undergoing carotid artery stenting (CAS) should receive DAPT before and for at least 3 months following their procedure (Class IIa, Level B-R). (11) In patients undergoing CAS during emergent large vessel occlusion ischemic stroke treatment, it may be reasonable to administer a loading dose of intravenous or oral glycoprotein IIb/IIIa or P2Y12 inhibitor followed by maintenance intravenous infusion or oral dosing to prevent stent thrombosis whether or not the patient has received thrombolytic therapy (Class IIb, C-LD). (12) For patients with cerebral venous sinus thrombosis, anticoagulation with heparin is front-line therapy; endovascular therapy may be considered particularly in cases of clinical deterioration despite medical therapy (Class IIa, Level B-R). CONCLUSIONS Although the quality of evidence is lower than for coronary interventions due to a lower number of patients and procedures, neurointerventional antiplatelet and antithrombotic management shares several themes. Prospective and randomized studies are needed to strengthen the data supporting these recommendations.
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Affiliation(s)
| | - Ketan R Bulsara
- Division of Neurosurgery, University of Connecticut, Farmington, Connecticut, USA
| | - Fawaz Al-Mufti
- Neurology, Neurosurgery, and Radiology, Westchester Medical Center, Valhalla, New York, USA
| | - Neil Haranhalli
- Neurosurgery and Radiology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Lucie Thibault
- Scientific Committee, World Federation of Interventional and Therapeutic Neuroradiology, Paris, France
| | - Steven W Hetts
- Radiology, Biomedical Imaging, and Neurological Surgery, UCSF, San Francisco, California, USA
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24
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Arauz A, Barboza MA, Quintero LC, Cantu C, Chiquete E, Serrano F. Prognosis of patients with severe cerebral venous thrombosis treated with decompressive craniectomy. Neurologia 2023; 38:617-624. [PMID: 37996212 DOI: 10.1016/j.nrleng.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/04/2021] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC. MATERIALS AND METHODS Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed. RESULTS Twenty-six patients were included (20 female, age 35.4±12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction±hemorrhagic lesion)>6cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization. CONCLUSION In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.
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Affiliation(s)
- A Arauz
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - M A Barboza
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico; Neurosciences Department, Hospital Dr. Rafael A. Calderón Guardia, CCSS, San José, Costa Rica.
| | - L C Quintero
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - C Cantu
- Stroke Clinic, Instituto Nacional de Ciencias Medicas y de la Nutricion Salvador Zubiran, Mexico City, Mexico
| | - E Chiquete
- Stroke Clinic, Instituto Nacional de Ciencias Medicas y de la Nutricion Salvador Zubiran, Mexico City, Mexico
| | - F Serrano
- Stroke Clinic, Instituto Nacional de Neurología and Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
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25
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Preul C, Alijaj L, Neumann-Haefelin T, Kallenberg K. [Venous thrombectomy in extensive cerebral venous sinus thrombosis and cerebrospinal fluid leakage after cesarean sectio under peridural anesthesia]. DER NERVENARZT 2023; 94:956-959. [PMID: 37106148 DOI: 10.1007/s00115-023-01485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Christoph Preul
- Klinik für Neurologie, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Deutschland.
| | - Lirim Alijaj
- Klinik für Neurologie, Klinikum Fulda gAG, Pacelliallee 4, 36043, Fulda, Deutschland
| | | | - Kai Kallenberg
- Klinik für Neuroradiologie, Klinikum Fulda gAG, Fulda, Deutschland
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Hagioka T, Shimizu T, Toyota S, Murakami T, Achiha T, Takahara M, Touhara K, Hoshikuma Y, Kobayashi M, Kishima H. Cerebral Venous Sinus Thrombosis Successfully Treated with Mechanical Thrombectomy under Intracranial Pressure Monitoring: A Case Report. NMC Case Rep J 2023; 10:241-245. [PMID: 37869376 PMCID: PMC10584664 DOI: 10.2176/jns-nmc.2023-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/21/2023] [Indexed: 10/24/2023] Open
Abstract
A 54-year-old man with no medical history presented to our hospital with vomiting, left hemiplegia, and seizures. On arrival, he was experiencing generalized tonic-clonic seizures, which required him to be intubated and deeply sedated. Contrast-enhanced computed tomography revealed extensive venous sinus obstruction from the superior sagittal sinus to the bilateral sigmoid sinus and cerebral edema with intracranial hemorrhage. An intracranial pressure (ICP) monitor was immediately placed intracranially, and mechanical thrombectomy (MT) was performed under ICP monitoring. MT was immediately terminated when the venous sinus was partially recanalized enough to decrease the ICP; then, anticoagulation therapy was initiated. Postoperative follow-up angiography revealed that venous sinus obstruction and intracranial venous perfusion improved over time. Although he had intracranial hemorrhage-induced left hemiplegia and sensory deficits, his condition improved with rehabilitation, and the patient was eventually discharged home. The indication criteria and techniques for MT for cerebral venous sinus thrombosis are yet to be established. As in this case, in patients with impaired consciousness due to intracranial hemorrhage or epilepsy, preoperative ICP monitor placement is deemed useful to evaluate venous perfusion during MT and decide the treatment goal.
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Affiliation(s)
- Tatsuya Hagioka
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Takeshi Shimizu
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Shingo Toyota
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Tomoaki Murakami
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Takamune Achiha
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Motohide Takahara
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Kazuhiro Touhara
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Yuhei Hoshikuma
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Maki Kobayashi
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Kim M, Subah G, Cooper J, Fortunato M, Nolan B, Bowers C, Prabhakaran K, Nuoman R, Amuluru K, Soldozy S, Das AS, Regenhardt RW, Izzy S, Gandhi C, Al-Mufti F. Neuroendovascular Surgery Applications in Craniocervical Trauma. Biomedicines 2023; 11:2409. [PMID: 37760850 PMCID: PMC10525707 DOI: 10.3390/biomedicines11092409] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Cerebrovascular injuries resulting from blunt or penetrating trauma to the head and neck often lead to local hemorrhage and stroke. These injuries present with a wide range of manifestations, including carotid or vertebral artery dissection, pseudoaneurysm, occlusion, transection, arteriovenous fistula, carotid-cavernous fistula, epistaxis, venous sinus thrombosis, and subdural hematoma. A selective review of the literature from 1989 to 2023 was conducted to explore various neuroendovascular surgical techniques for craniocervical trauma. A PubMed search was performed using these terms: endovascular, trauma, dissection, blunt cerebrovascular injury, pseudoaneurysm, occlusion, transection, vasospasm, carotid-cavernous fistula, arteriovenous fistula, epistaxis, cerebral venous sinus thrombosis, subdural hematoma, and middle meningeal artery embolization. An increasing array of neuroendovascular procedures are currently available to treat these traumatic injuries. Coils, liquid embolics (onyx or n-butyl cyanoacrylate), and polyvinyl alcohol particles can be used to embolize lesions, while stents, mechanical thrombectomy employing stent-retrievers or aspiration catheters, and balloon occlusion tests and super selective angiography offer additional treatment options based on the specific case. Neuroendovascular techniques prove valuable when surgical options are limited, although comparative data with surgical techniques in trauma cases is limited. Further research is needed to assess the efficacy and outcomes associated with these interventions.
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Affiliation(s)
- Michael Kim
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Galadu Subah
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Jared Cooper
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Michael Fortunato
- Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Bridget Nolan
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Christian Bowers
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87108, USA
| | - Kartik Prabhakaran
- Department of Surgery, Division of Trauma and Acute Care Surgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Rolla Nuoman
- Department of Neurology, Maria Fareri Children’s Hospital, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Krishna Amuluru
- Goodman Campbell Brain and Spine, Indianapolis, IN 46032, USA
| | - Sauson Soldozy
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Alvin S. Das
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Robert W. Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Saef Izzy
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Chirag Gandhi
- Department of Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
| | - Fawaz Al-Mufti
- Department of Neurology, Westchester Medical Center at New York Medical College, Valhalla, NY 10595, USA
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Piano M, Romi A, Cervo A, Gatti A, Macera A, Pero G, Motto C, Agostoni EC, Lozupone E. Endovascular Treatment of Cerebral Vein Thrombosis: Safety and Effectiveness in the Thrombectomy Era. Diagnostics (Basel) 2023; 13:2248. [PMID: 37443641 DOI: 10.3390/diagnostics13132248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare cause of stroke that tends to affect young people. Endovascular treatment (EVT) has not yet shown to be beneficial in CVT and is therefore actually only indicated as rescue therapy in severe and refractory cases for medical treatment. Clinical, neuroimaging, procedural and follow-up data were evaluated in order to define the safety and efficacy of EVT in the management of CVT between January 2016 and December 2022. Safety was assessed on the basis of recording adverse events. Functional outcomes (NIHSS, mRS) and neuroimaging were recorded at onset, at discharge and at a 6-month follow-up. Efficacy was assessed evaluating the recanalization rate at the end of the procedure. Twenty-one patients (17 female, 4 male, range 16-84 years) with CVT underwent EVT. Overall morbidity and mortality were both at 4.7%. Median NIHSS at the onset and at the discharge were, respectively, 10 and 2. Successful recanalization was achieved in 21/23 procedures (91.3%). Imaging follow-up (FUP) showed stable recanalization in all but one patient with successful recanalization. In 18/21 patients, a good clinical independence (mRS 0-2) was recorded at 6 months. Our study adds evidence on the safety and efficacy of endovascular techniques in the treatment of CVT.
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Affiliation(s)
- Mariangela Piano
- Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy
| | - Andrea Romi
- Neuroradiology Unit, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Amedeo Cervo
- Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy
| | - Antonella Gatti
- Neurology and Stroke Unit, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy
| | - Antonio Macera
- Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy
| | - Guglielmo Pero
- Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy
| | - Cristina Motto
- Neurology and Stroke Unit, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy
| | - Elio Clemente Agostoni
- Neurology and Stroke Unit, Department of Neuroscience, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162 Milano, Italy
| | - Emilio Lozupone
- Department of Neuroradiology, Vito-Fazzi Hospital, 73100 Lecce, Italy
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29
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Tang SZ, Jing M, Yang C, Yeo LLL, Tan BYQ, Chan BPL, Vijay KS, Teoh HL, Anil G. Safety and clinical outcomes in endovascular treatment for symptomatic cerebral venous thrombosis: a single-center experience with meta-analysis. Neurosurg Rev 2023; 46:114. [PMID: 37160781 DOI: 10.1007/s10143-023-02012-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/05/2023] [Accepted: 04/23/2023] [Indexed: 05/11/2023]
Abstract
The role of mechanical thrombectomy (MT) in cerebral venous sinus thrombosis (CVT) is ambiguous. This study aims to share our experience with MT in CVT, supplemented by a meta-analysis on this treatment. All patients who had MT for CVT at our institution, between 2016 and 2021, were retrospectively reviewed for treatment indications, the technique used, success and complication rates, and clinical outcomes. A meta-analysis was performed for clinical and safety outcomes from published literature with > 10 patients. A total of 15 patients were included in this study. All had a venous hemorrhage or deteriorating despite anticoagulation. MT was performed using aspiration (with wide bore catheters) in 7 patients: aspiration with stent retriever in 5 and transjugular Fogarty-balloon thrombectomy in 3 patients. Adjunctive intra-sinus thrombolysis (IST) was used in 4 cases and venoplasty in 3. Technical success (restoring antegrade venous flow on arterial injection) was 100% with no procedure-related major complication. The direct transjugular approach was cheaper and faster. At 3-month follow-up, 86% of patients had good outcomes (MRS < 2). Meta-analysis of clinical and safety outcomes from 22 and 20 studies, respectively, demonstrated a positive association between MT and good outcomes as well as no significant association with hazardous periprocedural events. EVT via mechanical means for CVT is feasible in our series and meta-analysis. From our experience, trans-jugular Fogarty balloon embolectomy seems to be a potential cost-saving option, at least in a certain part of the world.
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Affiliation(s)
- Si Zhao Tang
- Division of Interventional Radiology, Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore.
| | - Mingxue Jing
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Cunli Yang
- Division of Interventional Radiology, Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Leonard Litt Leong Yeo
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Benjamin Yong-Qiang Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Bernard Poon Lap Chan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Kumar Sharma Vijay
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Hock-Luen Teoh
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Gopinathan Anil
- Division of Interventional Radiology, Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
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30
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Lauzier D, Chatterjee A, Kansagra A. Neurointerventional management of cerebrovascular trauma. UKRAINIAN INTERVENTIONAL NEURORADIOLOGY AND SURGERY 2022. [DOI: 10.26683/2786-4855-2022-2(40)-41-54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Traumatic cerebrovascular injuries following blunt or penetrating trauma are common and carry a high risk of permanent disability or death. Proper screening, diagnosis, and treatment of these lesions is essential to improve patient outcomes. Advances in imaging continue to improve the accuracy of non-invasive diagnosis of these injuries while new clinical data provide better evidence for optimal management, whether medical or invasive. Here, we review screening, diagnosis, and treatment of traumatic cerebrovascular injuries.
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Cerebrovascular injuries in traumatic brain injury. Clin Neurol Neurosurg 2022; 223:107479. [DOI: 10.1016/j.clineuro.2022.107479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/22/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022]
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32
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Nakagawa I, Okamoto A, Kotsugi M, Yokoyama S, Yamada S, Nakase H. Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis after mRNA-based SIRS-CoV-2 vaccination. INTERDISCIPLINARY NEUROSURGERY 2022; 30:101644. [PMID: 35966341 PMCID: PMC9364928 DOI: 10.1016/j.inat.2022.101644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/19/2022] [Accepted: 08/07/2022] [Indexed: 12/04/2022] Open
Abstract
Background As vaccinations against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue worldwide, increased rates of venous thrombotic events, mainly as cerebral venous sinus thrombosis (CVST), have been reported following adenovirus vector-based SARS-CoV-2 vaccination. However, few reports have described the occurrence of venous thrombosis after messenger RNA (mRNA)-based vaccination. Here, we describe a case of CVST after a first dose of mRNA-based vaccination that was treated with emergent endovascular mechanical thrombectomy and systemic heparinization. Case Description. A 43-year-old, previously healthy man suffered severe headache and partial seizures affecting the left arm 4 days after receiving the first dose of an mRNA-based SARS-CoV-2 vaccination (FC3661; Pfizer/BioNTech). Computed tomography showed intraparenchymal hemorrhage. Seven days after vaccination, symptoms worsened and he was transferred to our tertiary hospital. Magnetic resonance venography revealed CVST with occlusion of the superior sagittal sinus (SSS) and right transverse sinus (TS). Since no findings suggested thrombosis with thrombocytopenia syndrome, the patient underwent systemic heparinization and emergent mechanical thrombectomy with balloon transluminal angioplasty, a stent retriever and an aspiration catheter. Complete SSS and right TS recanalization were achieved and the patient was discharged without neurological deficits. Conclusion Clinicians should be aware that apparently healthy individuals with no risk factors can develop CVST after receiving an mRNA-based vaccine and appropriate treatment including EMT need to be performed immediately. (228 words)
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Affiliation(s)
- Ichiro Nakagawa
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Ai Okamoto
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Masashi Kotsugi
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Shohei Yokoyama
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Shuichi Yamada
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hiroyuki Nakase
- Departments of Neurosurgery, Nara Medical University, Nara, Japan
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Cerebral Venous Sinus Thrombosis in a Patient With Alcohol Withdrawal Symptoms. Neurologist 2022:00127893-990000000-00047. [DOI: 10.1097/nrl.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Jedi F, Dethlefs G, Hauser TK, Hennersdorf F, Mengel A, Ernemann U, Bender B. Mechanical Thrombectomy in Cerebral Venous Sinus Thrombosis: Reports of a Retrospective Single-Center Study. J Clin Med 2022; 11:6381. [PMID: 36362608 PMCID: PMC9655339 DOI: 10.3390/jcm11216381] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/18/2022] [Accepted: 10/27/2022] [Indexed: 10/24/2023] Open
Abstract
Current standard care for acute cerebral venous sinus thrombosis (CVST) includes either intravenous heparin or subcutaneous low-molecular-weight heparin, but patients with refractory CVST, despite adequate anticoagulation therapy, may benefit from mechanical thrombectomy (MT). A retrospective study of patients with CVST, who underwent MT between 2011 and 2019, was performed looking at procedure success rate and clinical outcomes. Two raters evaluated the cerebral venous system of every patient before and after the intervention using the following scoring system: (0) No obvious thrombosis; (1) thrombosis without impaired blood flow; (2) thrombosis with impaired blood flow; (3) and thrombosis with complete vascular occlusion. The success of MT was measured using a score quotient (Q = A/B), dividing the sum of the patient's scores after the intervention (A) by the sum of scores before the intervention (B). Overall, 21 MTs were performed on 20 patients with refractory or severe CVST. Clinical improvement was seen in 61.9% during hospital stay and in 80% at 6-month follow-up, with complete recovery in 70% of patients. Patients with favorable outcomes had significantly lower recanalization quotients (p = 0.008). Our study provides evidence supporting that MT may be a safe and effective treatment with favorable clinical outcomes for selected patients with CVST.
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Affiliation(s)
- Farzaneh Jedi
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Gero Dethlefs
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Till-Karsten Hauser
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Florian Hennersdorf
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Annerose Mengel
- Department of Neurology and Stroke, Hertie-Institute for Clinical Brain Research, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, 72076 Tübingen, Germany
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35
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Montalvan V, Neves G, Bueso T, Ota R, Bushnaq S, Windisch T, Bushnaq S. Predicting poor response to anti-coagulation therapy in cerebral venous thrombosis using a simple clinical-radiological score. J Clin Neurosci 2022; 105:26-30. [PMID: 36058024 DOI: 10.1016/j.jocn.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/05/2022] [Accepted: 08/26/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Multiple studies have attempted to determine predictors of poor clinical outcomes in cerebral venous thrombosis (CVT). Fewer studies target to identify predictors of poor response to anticoagulation therapy in CVT. OBJECTIVE We aimed to determine the predictors of poor clinical response to therapeutic anticoagulation in patients with acute CVT. METHODS We performed a retrospective analysis of patients therapeutically anticoagulated for acute CVT. We defined poor clinical outcomes as death, need for mechanical thrombectomy during the hospitalization, or a modified Rankin Scale (mRS) > 3 at clinical follow-up. Bivariate and multivariate analyses identified factors associated with poor outcomes in anticoagulated patients for acute CVT, and we used the identified factors to create the PRACT-CVT (Poor Response to Anticoagulation Therapy in CVT) score. RESULTS We included 109 patients anticoagulated with acute CVT. The mean patient age was 37 years old (SD 19); nine patients were > 65 years, ten patients were < 10 years, and 64 (59%) were female. Twenty-one (19%) patients had poor clinical outcomes. Age > 65 or < 10 years (OR: 3.16, 95% CI: 1.06-9.44), a GCS ≤ 12 upon presentation (OR: 19.2, 95% CI: 4.05-91.4), focal motor deficits at admission (OR: 5.03, 95% CI: 1.64-15.44), clinical deterioration following admission (OR: 28.18, CI: 4.81-164.86), seizures following admission (OR: 5.59, 95% CI: 1.27-24.51), evidence of brain bleeding/ischemia on admission (OR: 4.67, 95% CI: 1.42-15.34), involvement of the superior sagittal sinus (OR: 3.88, CI: 1.33-11.32), or involvement of both transverse sinuses (OR: 3.87, 95% CI: 1.01-14.90) predicted poor clinical outcome despite therapeutic anticoagulation. A PRACT-CVT score (0-22 points) of ≥ 7 points provided a sensitivity of 71% and a specificity of 95% for predicting poor clinical outcomes with anticoagulation alone. CONCLUSION Patients with acute CVT aged > 65 or < 10 years old, presenting with a GCS ≤ 12, with focal motor deficits, showing clinical deterioration after admission, having clinical seizures during hospitalization, with brain bleeding/ischemia on initial neuroimaging, involvement of the superior sagittal sinus, or involvement of both transverse sinuses had poor response to anticoagulation. Clinicians may employ the PRACT-CVT score to predict poor response to anticoagulation for acute CVT.
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Affiliation(s)
- Victor Montalvan
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX, USA; Department of Neurology, Covenant Health System, Lubbock, TX, USA
| | - Gabriel Neves
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX, USA; Department of Neurology, Covenant Health System, Lubbock, TX, USA
| | - Tulio Bueso
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX, USA; Department of Neurology, Covenant Health System, Lubbock, TX, USA
| | - Riichi Ota
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX, USA; Department of Neurology, Covenant Health System, Lubbock, TX, USA
| | - Saji Bushnaq
- Department of Neurology, Ohio State University, Columbus, OH, USA
| | - Thomas Windisch
- Department of Neurology, Covenant Health System, Lubbock, TX, USA
| | - Saif Bushnaq
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX, USA; Department of Neurology, Covenant Health System, Lubbock, TX, USA
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36
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Siegler JE, Shu L, Yaghi S, Salehi Omran S, Elnazeir M, Bakradze E, Psychogios M, De Marchis GM, Yu S, Klein P, Abdalkader M, Nguyen TN. Endovascular Therapy for Cerebral Vein Thrombosis: A Propensity-Matched Analysis of Anticoagulation in the Treatment of Cerebral Venous Thrombosis. Neurosurgery 2022; 91:749-755. [PMID: 36001776 DOI: 10.1227/neu.0000000000002098] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endovascular treatment (EVT) for cerebral vein thrombosis (CVT) has not been proven to be more effective than anticoagulation based on recent results of the Thrombolysis or Anticoagulation for Cerebral Venous Thrombosis (TO-ACT) randomized clinical trial. OBJECTIVE To compare outcomes of EVT vs medical management in CVT. METHODS We compared EVT vs medical management in a retrospective multinational cohort of consecutive patients with CVT across 4 countries (USA, Italy, Switzerland, and New Zealand) and 27 sites (2015-2020), using propensity score matching (PSM) and inverse probability treatment weighting (IPTW), and meta-analyzed these results with the TO-ACT trial. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] 0-1) at 90 days. RESULTS Of the 987 patients, the mean age was 45.7 ± 16.9 years and 79 (8%) underwent EVT. With PSM (n = 124), there were no major differences in clinical or imaging features between groups other than a higher proportion of female patients receiving EVT (81% vs 65%, P = .04). There was no difference in the primary outcome with PSM (odds ratio [OR] 1.48, 95% CI, 0.55-3.96) or IPTW (OR 1.02, 95% CI, 0.34-3.06). EVT was associated with a higher 90-day shift in modified Rankin Scale (OR 2.00, 95% CI, 1.01-3.98) and mortality with IPTW (OR 4.60, 95% CI, 1.10-19.23) but no other differences in secondary outcomes with PSM or IPTW. A meta-analysis of primary and secondary outcomes from TO-ACT and PSM patients from anticoagulation in the treatment of cerebral venous thrombosis also showed no significant association with EVT in primary or secondary outcomes. CONCLUSION In this large observational cohort, there was no evidence of benefit with EVT for CVT. These findings corroborate the results from the TO-ACT trial.
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Affiliation(s)
- James E Siegler
- Department of Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - Liqi Shu
- Department of Neurology, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Shadi Yaghi
- Department of Neurology, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Setareh Salehi Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Marwa Elnazeir
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ekaterina Bakradze
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Marios Psychogios
- Department of Neuroradiology & Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology & Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Siyuan Yu
- Department of Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - Piers Klein
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
| | - Mohamad Abdalkader
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
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Epidemiology and Management of Cerebral Venous Thrombosis during the COVID-19 Pandemic. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081105. [PMID: 35892907 PMCID: PMC9332165 DOI: 10.3390/life12081105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/27/2022] [Accepted: 07/19/2022] [Indexed: 12/05/2022]
Abstract
Cerebral venous thrombosis (CVT) is a rare type of stroke that may cause an intracranial hypertension syndrome as well as focal neurological deficits due to venous infarcts. MRI with venography is the method of choice for diagnosis, and treatment with anticoagulants should be promptly started. CVT incidence has increased in COVID-19-infected patients due to a hypercoagulability state and endothelial inflammation. CVT following COVID-19 vaccination could be related to vaccine-induced immune thrombotic thrombocytopenia (VITT), a rare but severe complication that should be promptly identified because of its high mortality rate. Platelet count, D-dimer and PF4 antibodies should be dosed. Treatment with non-heparin anticoagulants and immunoglobulin could improve recuperation. Development of headache associated with seizures, impaired consciousness or focal signs should raise immediate suspicion of CVT. In patients who received a COVID-19 adenovirus-vector vaccine presenting thromboembolic events, VITT should be suspected and rapidly treated. Nevertheless, vaccination benefits clearly outweigh risks and should be continued.
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Endovascular Treatment of Intracranial Vein and Venous Sinus Thrombosis—A Systematic Review. J Clin Med 2022; 11:jcm11144215. [PMID: 35887982 PMCID: PMC9319519 DOI: 10.3390/jcm11144215] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Cerebral venous sinus or vein thromboses (SVT) are treated with heparin followed by oral anticoagulation. Even after receiving the best medical treatment, numerous patients experience neurological deterioration, intracerebral hemorrhage or brain edema. Debate regarding whether endovascular treatment (EVT) is beneficial in such severe cases remains ongoing. This systematic review summarizes the current evidence supporting the use of EVT for SVT on the basis of case presentations, with a focus on patient selection, treatment strategies and the effects of the COVID-19 pandemic. Methods: This systemic literature review included randomized controlled trials (RCTs) and retrospective observational data analyzing five or more patients. Follow-up information (modified Rankin scale (mRS)) was required to be provided (individual patient data). Results: 21 records (n = 405 patients; 1 RCT, 20 observational studies) were identified. EVT was found to be feasible and safe in a highly selected patient cohort but was not associated with an increase in good functional outcomes (mRS 0–2) in RCT data. In observational data, good functional outcomes were frequently observed despite an anticipated poor prognosis. Conclusion: The current evidence does not support the routine incorporation of EVT in SVT treatment. However, in a patient cohort prone to poor prognosis, EVT might be a reasonable therapeutic option. Further studies determining the patients at risk, choice of methods and devices, and timing of treatment initiation are warranted.
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Mera Romo WC, Ariza-Varón M, Escobar FN, Castillo AL. Cerebral venous sinus thrombosis treated with vacuum aspiration thrombectomy without thrombolysis: A descriptive and retrospective study of 5 years' experience at a single center. J Vasc Interv Radiol 2022; 33:1173-1183.e1. [PMID: 35835358 DOI: 10.1016/j.jvir.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 06/11/2022] [Accepted: 06/30/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Cerebral venous sinus thrombosis (CVST) is a rare but life-threatening condition. Mechanical thrombectomy is a treatment option for patients who deteriorate or do not improve despite anticoagulation treatment or who have a major contraindication to anticoagulation. The purpose of this study was to describe our 5 years of experience in treating CVST with vacuum aspiration thrombectomy without thrombolysis. MATERIALS AND METHODS For this retrospective study, data were collected from consecutive patients with CVST who received anticoagulation as initial medical treatment and then were treated with vacuum aspiration thrombectomy without thrombolysis. Patients were followed up at 3 months and after 1 year. RESULTS The 9 patients included in the study had a median age of 37 years, and 5 were female. All 9 patients had headache at presentation; 7 had focal neurologic deficits and 7 had intracranial hypertension. Risk factors for CVST were identified in 8 patients, and poor prognostic factors were identified in 7 patients. In the 9 patients, a total of 24 CVST locations were treated; complete (70.8%) or partial (29.2%) recanalization was achieved in all CVST locations. No procedure-related complications occurred. One patient died of parenchymal hemorrhagic transformation of CVST and vasogenic edema, at 6 hours after the procedure. Two patients required neurosurgical intervention. After 1 year (range, 13-30 months), all 8 surviving patients had good functional outcome (modified Rankin Scale score 0-2). CONCLUSIONS For appropriately selected patients with cerebral venous sinus thrombosis, vacuum aspiration thrombectomy without thrombolysis appears to be an effective therapy.
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Affiliation(s)
- Walter Camilo Mera Romo
- Department of Diagnostic Imaging, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, Colombia; Radiology Resident of Department of Diagnostic Imaging, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, Colombia.
| | - Michael Ariza-Varón
- Department of Clinical Neurology, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, Colombia; Research Group NeuroUnal, Department of Clinical Neurology, Universidad Nacional de Colombia, Bogotá, Colombia; Clinical Neurology Resident, Department Clinical Neurology of Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, D.C. Colombia
| | - Fabian Neira Escobar
- Department of Diagnostic Imaging, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, Colombia; Radiology Specialist, Universidad Nacional de Colombia, Bogotá, Colombia; Subspecialty in Oncological Radiology, Pontificia Universidad Javeriana, Interventional Radiologist, Hospital Universitario Nacional, Bogotá, D.C. Colombia; Subspecialty in Endovascular Neurointerventionism, Hospital General de Catalunya, Cataluña, Spain
| | - Alfonso Lozano Castillo
- Department of Diagnostic Imaging, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, Colombia; Radiology Specialist, Universidad Nacional de Colombia, Bogotá, Colombia
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Michiwaki Y, Yamane F, Tanaka T, Sashida R, Fujiwara R, Wakamiya T, Shimoji K, Suehiro E, Onoda K, Kawashima M, Matsuno A. Recanalization for straight sinus thrombosis through combined mechanical thrombectomy: A case report. Surg Neurol Int 2022; 13:293. [PMID: 35855139 PMCID: PMC9282811 DOI: 10.25259/sni_535_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 01/24/2023] Open
Abstract
Background: Systemic anticoagulation has been the standard treatment for cerebral venous sinus thrombosis (CVT). Although endovascular treatments, including mechanical thrombectomy (MT), have been reported to be effective for CVT, no clear evidence has been established. Case Description: A 51-year-old woman who had been administered oral contraceptive pills was transferred to our hospital with altered consciousness and disorientation. Computed tomography (CT) revealed a hyperdense signal in the straight sinus (StS), and CT angiography revealed a defect in the basal vein and StS, leading to a diagnosis of StS thrombosis. Although systemic anticoagulation through unfractionated heparin was performed, her neurological condition deteriorated, and venous ischemia was observed on CT the next day. She then underwent MT. Partial recanalization was achieved with an aspiration catheter and a stent retriever. Her neurological condition improved tremendously, and venous ischemia was reversed following MT. She was discharged 3 weeks later without neurological deficits with oral anticoagulant. Conclusion: This was a relatively rare case with CVT confined to StS. Immediate combined MT for StS thrombosis can improve venous circulation, make the venous ischemia reversible, and improve patient outcomes, even if it results in partial recanalization.
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Ye Y, Ding J, Liu S, Wen G, Huang S, Wang Q. A Transvenous Endovascular Approach in Straight Sinus has Minor Impacts on Chordae Willisii. Neurol India 2022; 70:1506-1511. [PMID: 36076651 DOI: 10.4103/0028-3886.355179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The transvenous endovascular approach has become an optimal method for the treatment of cerebrovascular diseases. This procedure might cause iatrogenic damage to the chordae willisii (CW) in the straight sinus. However, little literature has been found to support this hypothesis. Objective To investigate the possible damage of CW in the straight sinus during a transvenous endovascular procedure. Materials and Methods The features of the CW from 38 cadaveric heads were observed via an endoscope mimicking a mechanical thrombectomy procedure in the straight sinus. Endoscopic observation and light microscopy examination were used to assess the damage of the CW throughout the procedure. Results Valve-like lamellae and longitudinal lamellae were found predominantly in the posterior portion of the straight sinus. Trabeculae were present in both the anterior and posterior portions of the straight sinus. Samples treated with a stent had a significantly higher rate of Grade 1 damage during the eight procedures compared with samples treated with a balloon (P = 0.02). The incidence of damage to the CW surface was higher in the stent group than in the balloon group (P = 0.00). The use of stent or balloon did not increase the rate of CW damage during repeated experiments. Conclusions The stent or balloon navigation through the straight sinus can cause minor damage to the CW. Frequent uses of retrograde navigation through the straight sinus do not seem to increase the possibility of damage to CW.
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Affiliation(s)
- Yuanliang Ye
- Department of Neurosurgery, Liuzhou People's Hospital, Liuzhou, Guangxi Autonomous Region; Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jiuyang Ding
- Department of Forensic Medicine, Guizhou Medical University, Guiyang, Guizhou, China
| | - Shoutang Liu
- Department of Neurosurgery, Liuzhou People's Hospital, Liuzhou, Guangxi Autonomous Region, China
| | - Ge Wen
- Department of Research, The Bioillus Institute of Technology, Guangzhou, Guangdong Province, China
| | - Shaoming Huang
- Department of Anatomy, Guangxi Medical University, Nanning, Guangxi Autonomous Region, China
| | - Qiujing Wang
- Department of Cerebrovascular Surgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
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Cerebrovascular intervention therapy worked positively in one patient with severe cerebral venous sinus thrombosis due to hyperthyroidism: a case report and review of the literature. J Med Case Rep 2022; 16:250. [PMID: 35752821 PMCID: PMC9233794 DOI: 10.1186/s13256-022-03463-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background With further understanding of cerebral venous sinus thrombosis, hyperthyroidism has gradually been revealed as a rare predisposing factor for cerebral venous sinus thrombosis, which may present as more compact clots and resistance to fibrinolysis, also known as a predictor of worse outcomes. For patients with severe cerebral venous sinus thrombosis, proper treatment method should be initiated as soon as possible since they may deteriorate rapidly. Case presentation In this case report, we present a 32-year-old Mongoloid woman admitted with progressive headache, impaired consciousness, and right limb weakness, diagnosed with cerebral venous sinus thrombosis caused by hyperthyroidism. A cerebrovascular intervention with local thrombolytic infusion was performed at the site of thrombosis, followed by dilatation with balloon and thrombus aspiration in venous sinus, with partial recanalization observed and anticoagulation given as a next step. After cerebrovascular intervention, the patient’s condition improved rapidly and she was discharged with her National Institute of Health Stroke Scale score being decreased from 17 to 2. Conclusions When patients with hyperthyroidism suffer from headache, progressive disturbance of consciousness, seizures, and other symptoms, the presence of cerebral venous sinus thrombosis should be considered and corresponding examinations should be performed as soon as possible. For patients with severe cerebral venous sinus thrombosis, cerebrovascular intervention might be a safe and effective approach if conventional management fails.
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Wang C, Sun J, Shao J, Zhang X, Chen X. Clinical Observation and Value Analysis of Endovascular Interventional Therapy for Intracranial Venous Sinus Thrombosis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4931210. [PMID: 35747500 PMCID: PMC9213190 DOI: 10.1155/2022/4931210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/29/2022] [Accepted: 05/07/2022] [Indexed: 11/17/2022]
Abstract
The main aim of this study was to investigate the therapeutic effect of endovascular interventional therapy on cerebral venous sinus thrombosis (CVST). 137 patients with CVST were included, 92 patients were treated with interventional therapy, and 45 patients were treated with conventional anticoagulant therapy. Through endovascular therapy (EVT) combined with therapy, the patients were treated with EVT in combination with conventional anticoagulant therapy, and the prognosis of the two groups of patients was evaluated. The results showed that 26 patients were complicated with female-specific infections in the combined EVT group, and 7 patients had female-specific infections in the simple anticoagulant therapy (LMWH) group. In terms of central nervous system infections, the EVT group was significantly lower than the LMWH group, P < 0.001, and the difference was statistically significant. There were 2 cases of EVT involving the inferior sagittal sinus and 12 cases of LMWH involving the inferior sagittal sinus, P < 0.001, and the difference had statistical significance. Through the RANKIN scale (mRS) score, it was classified as complete recovery and good prognosis (dependent variable). The patients receiving EVT with good prognosis (96.7%) were more than those receiving simple anticoagulant therapy (84.4%), and 78.3% were completely recovered after EVT, and 77.5% were completely recovered after anticoagulant therapy. Therefore, it can be concluded that gender, malignant tumors, thrombosis, and sinuses are all risk factors affecting the prognosis of patients; both endovascular interventional therapy and anticoagulant therapy can significantly improve the prognosis of patients.
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Affiliation(s)
- Cheng Wang
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Jun Sun
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Junfei Shao
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xiaolu Zhang
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Xiang Chen
- Department of Neurosurgery, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
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Higaki R, Yamaguchi S, Haruyama H, Osaki M, Arakawa S, Sayama T. Effectiveness of the Digging through Thrombus Technique by Using an Aspiration Catheter and Stent Retriever for Cerebral Venous Thrombosis. Neurol Med Chir (Tokyo) 2022; 62:336-341. [PMID: 35613878 PMCID: PMC9357457 DOI: 10.2176/jns-nmc.2021-0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cerebral venous thrombosis (CVT) is a rare cause of stroke, and the first-line treatment is systemic anticoagulation. Patients unresponsive to standard therapy for CVT present with rapid neurological deterioration and require endovascular treatment. We encountered two patients with severe CVT who underwent endovascular treatment. In our cases, the thrombus was too hard and extensive to pass through using currently existing techniques. We performed the "digging through thrombus technique" using an aspiration catheter and stent retriever and achieved rapid sinus recanalization and favorable outcomes.
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Affiliation(s)
- Rio Higaki
- Department of Neurosurgery, Steel Memorial Yawata Hospital
| | | | | | - Masato Osaki
- Department of Cerebrovascular Disease, Steel Memorial Yawata Hospital
| | - Shuji Arakawa
- Department of Cerebrovascular Disease, Steel Memorial Yawata Hospital
| | - Tetsuro Sayama
- Department of Neurosurgery, Steel Memorial Yawata Hospital
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Shen J, Tao Z, Chen W, Sun J, Li Y, Fu F. Malignant Isolated Cortical Vein Thrombosis as the Initial Manifestation of Primary Antiphospholipid Syndrome: Lessons on Diagnosis and Management From a Case Report. Front Immunol 2022; 13:882032. [PMID: 35547735 PMCID: PMC9082262 DOI: 10.3389/fimmu.2022.882032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022] Open
Abstract
Background Antiphospholipid syndrome (APS) with isolated cortical vein thrombosis (ICoVT) is an extremely rare but potentially malignant entity. It is particularly challenging to diagnose APS-related ICoVT because of the non-specific clinical manifestations and the frequent absence of typical neuroimaging. Moreover, there is currently limited knowledge on the clinical features and management strategies for the condition. Delays in diagnosis and treatment may lead to life-threatening consequences. Case Presentation We present a rare case of a 74-year-old Chinese woman who presented with sudden onset of headache and right arm weakness that mimicked acute ischemic stroke. Her initial computed tomography was unremarkable, and intravenous thrombolysis was performed. Serial neuroimages confirmed ICoVT 4 days after symptom onset, and low-molecular-weight heparin (LMWH) was started at a dose of 0.4 ml twice per day, according to the 2019 Chinese guidelines. The workup for the predisposing causes of ICoVT revealed triple positivity APS. LMWH dose was adjusted according to the anti-Xa chromogenic assay. However, the patient’s condition deteriorated rapidly, and there was a progressive enlargement of the venous infarction despite treatment with anticoagulants. Transtentorial herniation developed on day 12, and decompressive craniectomy was immediately performed. The patient’s symptoms did not improve significantly after surgery, and she remained aphasic and hemiplegic at the 3-month follow-up, with a modified Rankin Scale score of 5. Conclusion ICoVT is a rare yet potentially fatal manifestation of APS, and its diagnosis and treatment are extremely challenging. Timely diagnosis, prompt treatment, and close monitoring are essential to improve the clinical prognosis of patients with APS-related ICoVT.
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Affiliation(s)
- Jie Shen
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zi Tao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Chen
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jing Sun
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yan Li
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fangwang Fu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Heckelmann J, Dafotakis M, Schulz JB. [Cerebral venous sinus thrombosis : An overview of causes, diagnostics and treatment]. DER NERVENARZT 2022; 93:413-421. [PMID: 35412038 PMCID: PMC9004207 DOI: 10.1007/s00115-022-01283-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/28/2022]
Abstract
Die Sinus‑/Hirnvenenthrombose ist eine teils fulminant verlaufende, jedoch mit einer Inzidenz von 1,32 Fällen pro 100.000 Personenjahre eher seltene neurologische Diagnose. Nichtsdestotrotz ist die Erkrankung für etwa 0,5–1 % aller Schlaganfälle verantwortlich. Die neurologische Untersuchung zeigt oft ein unspezifisches Bild, gerade bei jüngeren Patientinnen mit akut bis subakut aufgetretenen, lageabhängigen Kopfschmerzen sollte diese Differenzialdiagnose jedoch unbedingt bedacht werden. Im Rahmen dieses Artikels erfolgt die Präsentation der häufigsten Ursachen, einschließlich eines Exkurses zur vakzininduzierten immunthrombotischen Thrombozytopenie (VITT), und es werden Empfehlungen zur klinischen, laborchemischen und bildgebenden Diagnostik gegeben. Zudem werden relevante Komplikationen, mit besonderem Augenmerk auf epileptische Anfälle im Rahmen der Krankheitsentität und die leitliniengemäße Akuttherapie und Sekundärprophylaxe dargestellt.
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Affiliation(s)
- Jan Heckelmann
- Neurologische Klinik, Universitätsklinik der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - Manuel Dafotakis
- Neurologische Klinik, Universitätsklinik der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland
| | - Jörg B Schulz
- Neurologische Klinik, Universitätsklinik der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
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Kakovan M, Shirkouhi SG, Zarei M, Andalib S. Stroke Associated with COVID-19 Vaccines. J Stroke Cerebrovasc Dis 2022; 31:106440. [PMID: 35339857 PMCID: PMC8894799 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106440] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/28/2021] [Accepted: 12/11/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives Development of safe and effective vaccines against coronavirus disease 2019 (COVID-19) remains the cornerstone of controlling this pandemic. However, there are increasing reports of various types of stroke including ischemic stroke, and hemorrhagic stroke, as well as cerebral venous sinus thrombosis (CVST) after COVID-19 vaccination. This paper aims to review reports of stroke associated with COVID-19 vaccines and provide a coherent clinical picture of this condition. Materials and methods A literature review was performed with a focus on data from recent studies. Results Most of such patients are women under 60 years of age and who had received ChAdOx1 nCoV-19 vaccine. Most studies reported CVST with or without secondary ischemic or hemorrhagic stroke, and some with Vaccine-induced Thrombotic Thrombocytopenia (VITT). The most common clinical symptom of CVST seen after COVID-19 vaccination was headache. The clinical course of CVST after COVID-19 vaccination may be more severe than CVST not associated with COVID vaccination. Management of CVST following COVID-19 vaccination is challenging and may differ from the standard treatment of CVST. Low molecular weight heparin is commonly used in the treatment of CVST; however, it may worsen outcomes in CVST associated with VITT. Furthermore, administration of intravenous immunoglobulin and high-dose glucocorticoids have been recommended with various success rates. Conclusion These contradictory observations are a source of confusion in clinical decision-making and warrant further study and development of clinical guidelines. Clinicians should be aware of clinical presentation, diagnosis, and management of stroke associated with COVID-19 vaccination.
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Gurjar H, Dhallu M, Lvovsky D, Sadullah S, Chilimuri S. A Rare Case of Coronavirus Disease 2019 Vaccine-Associated Cerebral Venous Sinus Thrombosis Treated with Mechanical Thrombectomy. Am J Case Rep 2022; 23:e935355. [PMID: 35181646 PMCID: PMC8870012 DOI: 10.12659/ajcr.935355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Vaccine-related thrombosis and thrombocytopenia syndrome (TTS) is a rare life-threatening syndrome reported after vaccination against COVID-19. CASE REPORT We describe a case of 56-year-old postmenopausal, obese woman with hypothyroidism and hyperlipidemia, who presented to the Emergency Department (ED) with fluctuating mental status and left-side weakness for 5 days. She received her first and second dose of mRNA-1273 vaccine (Moderna) at 12 and 8 weeks, respectively, prior to presentation. She was found to have multiple hemorrhages and infarcts on a computed tomography (CT) scan of the head. She was intubated in the ED for airway protection and mechanically ventilated. Magnetic resonance angiogram and venogram showed multiple infarcts in right frontal, parietal, and left parietal lobes, along with occlusion of left-side transverse sinus, sagittal sinuses, and left internal jugular vein, suggesting cerebral venous sinus thrombosis (CVST). Despite anticoagulation, her clinical condition continued to worsen, and she was referred for emergent endovascular thrombectomy. Her clinical condition improved after thrombectomy, and she was discharged on warfarin. At 4-month follow-up, she was able to walk with an assistive device and able to carry out activities of daily living with assistance. She is planned for further work-up for hypercoagulable state at follow-up. CONCLUSIONS This case highlights the occurrence of vaccine-related thrombosis 3 months after vaccine administration. Only 2 cases of TTS have been reported so far after mRNA-1273 vaccination (Moderna). To the best of our knowledge, this is the first reported case of CVST presenting 3 months after the first dose of COVID-19 mRNA-1273 vaccine (Moderna).
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Affiliation(s)
- Hitesh Gurjar
- Department of Internal Medicine, BronxCare Hospital Center; Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Manjeet Dhallu
- Department of Internal Medicine and Division of Neurology, BronxCare Hospital Center; Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Dmitry Lvovsky
- Department of Internal Medicine and Division of Pulmonary and Critical Care, BronxCare Hospital Center; Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Samiyah Sadullah
- Department of Internal Medicine, BronxCare Hospital Center; Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Sridhar Chilimuri
- Department of Internal Medicine, BronxCare Hospital Center; Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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Ye Y, Ding J, Liu S, Lan T, Chen L, Wang Y, Xia B, Yang J. A Transvenous Endovascular Approach in Straight Sinus Has Minor Impacts on Chordae Willisii. Front Neurol 2022; 13:725703. [PMID: 35222237 PMCID: PMC8874329 DOI: 10.3389/fneur.2022.725703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Cerebral dural sinuses contain different types of chordae willisii (CW). The transvenous endovascular approach, which has become an optimal method for the treatment of cerebrovascular diseases, such as malformation, fistula, and chronic intracranial hypertension, due to sinus thromboses, frequently uses retrograde navigation through dural sinuses. Whether or how much the endoscopic procedure damages the chordae willisii is often not well-assessed. In our study, an overall number of 38 cadaveric heads were analyzed for the distribution and features of the chordae willisii in the straight sinus. We used an endoscope on these samples mimicking a mechanical thrombectomy procedure performed in the straight sinus. Both endoscopic gross observation and light microscopic histological examination were used to assess the damages to the chordae willisii by the procedure. We found that the valve-like lamellae and longitudinal lamellae structures were mainly found in the posterior part of straight sinus whereas trabeculae were present in both anterior and posterior portions. We treated a group of samples with a stent and another with a balloon. The stent-treated group had a significantly higher rate of Grade 1 damage comparing with the balloon-treated group (p = 0.02). The incidence of damage to the surface of chordae willisii was also higher in the stent-treated group (p = 0.00). Neither the use of stent nor of balloon increased the rate of damage to chordae willisii during repeated experiments. These findings indicated that stent or balloon navigation through the straight sinus can cause minor damages to the chordae willisii and frequent uses of retrograde navigation through the straight sinus do not appear to increase the rates of damage to chordae willisii.
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Affiliation(s)
- Yuanliang Ye
- Department of Neurosurgery, Liuzhou People's Hospital, Liuzhou, China
| | - Jiuyang Ding
- School of Forensic Medicine, Guizhou Medical University, Guiyang, China
| | - Shoutang Liu
- Department of Neurosurgery, Liuzhou People's Hospital, Liuzhou, China
| | - Tiancai Lan
- Department of Neurosurgery, Liuzhou People's Hospital, Liuzhou, China
| | - Long Chen
- Department of Neurosurgery, Liuzhou People's Hospital, Liuzhou, China
| | - Yingxue Wang
- School of Forensic Medicine, Guizhou Medical University, Guiyang, China
| | - Bing Xia
- School of Forensic Medicine, Guizhou Medical University, Guiyang, China
- Bing Xia
| | - Jianqing Yang
- Department of General Surgery, Liuzhou People's Hospital, Liuzhou, China
- *Correspondence: Jianqing Yang
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Elsherbini MM, Badr H, Khalil AF. Efficiency of decompressive craniectomy as a line of management of severe cerebral venous thrombosis. J Cerebrovasc Endovasc Neurosurg 2022; 24:129-136. [PMID: 35108760 PMCID: PMC9260463 DOI: 10.7461/jcen.2022.e2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Cerebral venous thrombosis (CVT) is a rare pathology with life threatening consequences, most of these fatal complications are due to raised intracranial pressure due to venous infarction and cerebral swelling, the purpose of this study is to evaluate the efficiency of decompressive craniectomy for favorable outcome. Methods A retrospective analysis of clinical, radiological and surgical data of patients who underwent decompressive craniectomy for CVT in a tertiary referral hospital between the years 2016 through 2020. Results The study included 7 patients, female predominance was noted (5/7), mean age was 18.14 years. Mean Glasgow coma score (GCS) at surgery was 8.26, good clinical outcome was achieved for the majority of cases 71.4%, and one case of mortality 14.28%. Conclusions Decompressive craniectomy is a life saving procedure for patients with severe brain swelling as a sequela of CVT, majority of patients (71.4%) showed favorable functional outcome by 6 months postoperatively.
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Affiliation(s)
- Mohamed M Elsherbini
- Department of Neurosurgery, Mansoura University Hospital, Mansoura University, Mansoura, Egypt
| | - Hatem Badr
- Department of Neurosurgery, Mansoura University Hospital, Mansoura University, Mansoura, Egypt
| | - Amr Farid Khalil
- Department of Neurosurgery, Mansoura University Hospital, Mansoura University, Mansoura, Egypt
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