Endovascular treatment for cerebral venous sinus thrombosis - a single center study.

Autor: Andersen TH; Department of Radiology, Neurovascular Section, Copenhagen University Hospital, Rigshospitalet, Denmark., Hansen K; Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark., Truelsen T; Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark., Cronqvist M; Department of Radiology, Neurovascular Section, Copenhagen University Hospital, Rigshospitalet, Denmark., Stavngaard T; Department of Radiology, Neurovascular Section, Copenhagen University Hospital, Rigshospitalet, Denmark., Cortsen ME; Department of Radiology, Neurovascular Section, Copenhagen University Hospital, Rigshospitalet, Denmark., Holtmannspötter M; Department of Radiology, Neurovascular Section, Copenhagen University Hospital, Rigshospitalet, Denmark., Højgaard JLS; Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark., Stensballe J; Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Denmark.; Department of Anesthesiology, Centre of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Denmark., Welling KL; Department of Neuroanesthesiology, Copenhagen University Hospital, Rigshospitalet, Denmark., Gutte H; Department of Radiology, Neurovascular Section, Copenhagen University Hospital, Rigshospitalet, Denmark.
Jazyk: angličtina
Zdroj: British journal of neurosurgery [Br J Neurosurg] 2021 Jun; Vol. 35 (3), pp. 259-265. Date of Electronic Publication: 2020 Jul 10.
DOI: 10.1080/02688697.2020.1786498
Abstrakt: Background: Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disorder. The majority of these patients respond favorably to systemic anticoagulation. However, a subset of patients will deteriorate clinically, despite optimal medical therapy.
Methods: Retrospective single center study of 28 consecutive CVST patients treated with systemic anticoagulation and additional endovascular therapy.
Results: Median age was 37.5 years (range 15-76 years), there were 21 (75%) women, and 20 (71%) had thrombosis involving ≥2 venous sinuses. Intracranial hemorrhage (ICH) was present at admission in 18 patients (64%). Endovascular therapy consisted of local thrombolysis in 26 (93%) patients; 9 patients (32%) had additional mechanical thrombectomy, and in 2 (7%) patients thrombectomy alone was performed. Complete recanalization at end of the final intervention was achieved in 15 patients (54%), partial recanalization in 11 patients (39%), whereas there was no recanalization in 2 patients (7%). On follow-up imaging, conducted between 3 and 6 months, recanalization further improved to 76%, 19% and 5%, respectively. A favorable outcome (mRS ≤ 2) was achieved in 63% of patients at 3 months, which improved to 79% at 6 months. Post-procedural ICH or volume expansion of preexisting ICH was seen in 9 patients (32%). In total 5 patients died (18%).
Conclusions: Systemic anticoagulation with the addition of endovascular therapy with local thrombolysis and/or mechanical thrombectomy is a potential strategy to obtain recanalization in patients with CVST who deteriorate clinically despite medical therapy or are comatose. Endovascular therapy may increase the risk of ICH.
Databáze: MEDLINE
Externí odkaz: