Aggressive treatment of cerebral venous sinus thrombosis (CVT) with stent retrievers and local thrombolysis: why we need a registry

 

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Abstract

Purpose Anticoagulation is the first-line therapy for cerebral venous sinus thrombosis (CVT). Endovascular treatment is increasingly applied in patients deteriorating despite anticoagulation with extensive thrombosis or contraindications for anticoagulation. Experience with stent retrievers in CVT is limited.

Results We present three cases of severe CVT treated with stent-retrievers, thrombus aspiration and local thrombolysis. In two patients with extensive thrombosis, a partial recanalization was achieved, but only one of them showed significant improvement. Despite failed recanalization, the third patient recovered completely.

Conclusions Limited experience with three cases indicates that recanalization may not necessarily result in favourable clinical outcome even in severely affected patients. Therefore, invasive procedures such as local thrombolysis and thrombectomy remain individual therapeutic options when anticoagulation fails and in patients with extensive thrombosis.

Zusammenfassung

Hintergrund Antikoagulation ist bislang die Standardtherapie bei zerebraler Sinus-/Hirnvenenthrombose (CVT). Endovaskuläre Strategien werden zunehmend bei Verschlechterung unter Antikoagulation, ausgedehnten Thrombosen oder Kontraindikationen gegen die Antikoagulation eingesetzt, jedoch gibt es wenig Erfahrung speziell mit Stent-Retrievern bei CVT.

Ergebnisse Wir stellen 3 Fallberichte schwerwiegender CVT vor, welche mit Stent-Retrievern, Thrombektomie und lokaler Thrombolyse behandelt wurden. Bei partieller Rekanalisation in 2 Fällen kam es nur bei einem zu einer deutlichen Besserung. Trotz erfolgloser Rekanalisation zeigte die dritte Patientin einen sehr guten klinischen Verlauf.

Schlussfolgerung Unsere kleine Fallserie deutet darauf hin, dass Rekanalisation allein möglicherweise nicht zwingend zu einem günstigen klinischen Ergebnis führt. Invasive Therapien sind nach wie vor individuelle Therapieoptionen, wenn Antikoagulation nicht ausreicht und wenn die Thrombuslast groß ist.

• References

• 1 Saposnik G, Barinagarrementeria F, Brown Jr RD. et al. American Heart Association Stroke Council and the Council on Epidemiology and Prevention. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association.. Stroke 2011; 42: 1158-92
  CrossrefPubMedGoogle Scholar
• 2 Siddiqui FM, Dandapat S, Banerjee C. et al. Mechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases.. Stroke 2015; 46: 1263-8
  CrossrefPubMedGoogle Scholar
• 3 Dorn F, Stehle S, Lockau H. et al. Endovascular treatment of acute intracerebral artery occlusions with the solitaire stent: single-centre experience with 108 recanalization procedures.. Cerebrovasc Dis 2012; 34: 70-7
  CrossrefPubMedGoogle Scholar
• 4 Froehler MT. Successful treatment of cerebral venous sinus thrombosis with the Solitaire FR thrombectomy device.. J Neurointerv Surg 2013; 5: e45
  CrossrefPubMedGoogle Scholar
• 5 Pukenas BA, Kumar M, Stiefel M. et al. Solitaire FR device for treatment of dural sinus thrombosis.. J Neurointerv Surg 2014; 6: e2
  CrossrefPubMedGoogle Scholar
• 6 Raychev R, Tateshima S, Rastogi S. et al. Successful treatment of extensive cerebral venous sinus thrombosis using a combined approach with Penumbra aspiration system and Solitaire FR retrieval device.. J Neurointerv Surg 2014; 6: e32
  CrossrefPubMedGoogle Scholar
• 7 Shaikh H, Pukenas BA, McIntosh A. et al. Combined use of Solitaire FR and Penumbra devices for endovascular treatment of cerebral venous sinus thrombosis in a child.. J Neurointerv Surg 2015; 7: e10
  CrossrefPubMedGoogle Scholar
• 8 Choudhri O, Feroze A, Marks MP. et al. Endovascular management of cerebral venous sinus thrombosis.. Neurosurg Focus 2014; 37 (Suppl. 01) 1
  CrossrefPubMedGoogle Scholar
• 9 Putaala J, Hiltunen S, Salonen O. et al. Recanalization and its correlation to outcome after cerebral venous thrombosis.. J Neurol Sci 2010; 292: 11-5
  CrossrefPubMedGoogle Scholar
• 10 Lozano-Ros A, Luque-Buzo E, García-Pastor A. et al. Endovascular treatment of cerebral venous sinus thrombosis (CVST): Is a complete recanalization required for a good clinical outcome?. J Neuroradiol 2016; 43: 51-4
  CrossrefPubMedGoogle Scholar
• 11 Herweh C, Griebe M, Geisbüsch C. et al. Frequency and temporal profile of recanalization after cerebral vein and sinus thrombosis.. Eur J Neurol 2016; 23: 681-7
  CrossrefPubMedGoogle Scholar
• 12 Coutinho JM, Ferro JM, Zuurbier SM. et al. Thrombolysis or anticoagulation for cerebral venous thrombosis: rationale and design of the TO-ACT trial.. Int J Stroke 2013; 8: 135-40
  CrossrefPubMedGoogle Scholar