Management and outcome of spontaneous cerebral venous sinus thrombosis in a 5-year consecutive single-institution cohort

2016 ◽  
Vol 9 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Darrin J Lee ◽  
Arjang Ahmadpour ◽  
Tamar Binyamin ◽  
Brian C Dahlin ◽  
Kiarash Shahlaie ◽  
...  
Keyword(s):  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Anticoagulation Therapy ◽  
Transverse Sinus ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Dural Sinus ◽  
Venous Sinus Thrombosis ◽  
Sagittal Sinus ◽  
The Impact

BackgroundCerebral venous sinus thrombosis (CVST) is an uncommon form of stroke with a variable presentation, ranging from headaches, to coma and death. Although the American Stroke Association has developed guidelines for the treatment of CVST, data are sparse on the outcome after treatment with anticoagulation, thrombolysis, and thrombectomy.MethodsIn this retrospective review, we describe the 5-year UC Davis experience with spontaneous CVST.ResultsForty-one patients (mean age 37.5±23.1, range 0–96 years; 29 female) were identified with CVST. The majority of cases involved the transverse sinus (75.6%), sigmoid sinus (58.5%), and superior sagittal sinus (29.3%). The most common form of treatment was anticoagulation or antiplatelet therapy (n=35), while six patients were managed by observation alone. The overall 1-year modified Rankin score (mRS) was 1.4±1.5. Male patients and patients with a poor admission mRS had a worse outcome. Outcome was unaffected by hypercoagulable state, number of dural sinuses involved, the presence of intracranial hemorrhage, or seizures. Two patients who underwent anticoagulation therapy also required endovascular thrombectomy; both patients had a 1-year mRS of ≤2. Two patients underwent direct open surgical canalization of the superior sagittal sinus with varying outcomes (mRS 2 vs mRS 6).ConclusionsIn our series, the majority (92.9%) of patients with spontaneous dural sinus thrombosis had a favorable clinical outcome as defined by a mRS ≤2. Further prospective studies are needed to study the impact of anticoagulation on the clinical course of the disease.

Abstract 1122‐000212: INARI FlowTriever system: First Endovascular Clinical Experience to Treat Diffuse Cerebral Venous Sinus Thrombosis

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Samer Abdul Kareem ◽  
Saif Bushnaq ◽  
Nicholas Liaw ◽  
Bader Alenzi ◽  
Muhammad Khaleeq ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Endovascular Techniques ◽  
Venous Thrombectomy ◽  
Venous Sinus Thrombosis ◽  
Sagittal Sinus ◽  
Clot Burden

Introduction : Cerebral Venous Sinus Thrombosis (CVST) is a rare stroke with a wide range of symptomatology at presentation ranging from headache, focal weakness, and coma. Anticoagulation remains the mainstay of treatment. However, in a subset of patients endovascular treatment can be potentially beneficial. Here we describe the first clinical experience using the INARI FlowTriever system to treat a patient presented with focal weakness and found to have diffuse cerebral venous sinus thrombosis. Methods : Case report of CSVT treated with INARI FlowTriever system. Results : A 78‐year‐old female with past medical history of Autoimmune hepatitis and hypothyroidism, was brought to the hospital with left arm weakness. CT head revealed left temporoparietal intraparenchymal hemorrhage and right frontal subarachnoid hemorrhage. CTA of the head and neck revealed extensive CVST involving superior sagittal sinus, bilateral transverse and sigmoid sinuses. She was started on heparin drip. Patient was taken for venous thrombectomy due to persistent left‐sided weakness and multicompartment bleeding while being on anticoagulation for 48 hours. She underwent successful endovascular venous thrombectomy using the INARI FlowTriever system with large clot burden extracted. She was switched to novel oral anticoagulation prior to discharge. During the 3 months follow‐up–MRI brain with and without contrast revealed near complete resolution of the clot burden in the superior sagittal sinus and left transverse/sigmoid complex and her modified Rankin score was at 0. Conclusions : Here we discussed a case of diffuse CVST who was treated initially with heparin drip then underwent endovascular venous thrombectomy using INARI FlowTriever system with large clot burden aspirated with a reasonable safety profile. The INARI medical FlowTriever system is the only mechanical thrombectomy system indicated for the treatment of pulmonary embolism. It is specifically designed for venous clots. It is composed of a trackable large bore aspiration catheter. The INARI FlowTriever Catheter; has 3 expanding nitinol mesh disks; designed to engage and disrupt venous clots and subsequently deliver it to the large bore aspiration catheter. Its larger size makes it an attractive candidate for venous sinus clot retrieval. This study illustrates the first clinical use of INARI thrombectomy device in CVST with a reasonable safety profile. Anticoagulation is the mainstay first line treatment for CVST. However, a small subset of patients would potentially benefit from endovascular treatment but it still uncertain how to select these patients and what is the best timeline to offer early endovascular treatment. Various neuro endovascular techniques has been attempted to treat cerebral venous sinus thrombosis. However; it is unclear which approach and device provides the optimal restoration of venous blood flow. Current neuro endovascular techniques and devices are not particularly designed for CVST pathology treatment and there is need for further innovation and new devices.

scholarly journals Stenting for acute cerebral venous sinus thrombosis in the superior sagittal sinus

2015 ◽  
Vol 21 (6) ◽  
pp. 719-723 ◽  
Author(s):  
Hidemitsu Adachi ◽  
Yohei Mineharu ◽  
Tatsuya Ishikawa ◽  
Hirotoshi Imamura ◽  
Shiro Yamamoto ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Balloon Angioplasty ◽  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Digital Subtraction ◽  
Thrombus Aspiration ◽  
Venous Sinus Thrombosis ◽  
Sagittal Sinus

Endovascular treatment for superior sagittal sinus (SSS) thrombosis is not always successful because of difficult access and long thrombus lesions. We report the first two cases of patients with acute cerebral venous sinus thrombosis at the SSS that was not recanalized by anticoagulation, mechanical thrombectomy, or thrombolysis, but was successfully treated by stent placement. Case 1 was a 37-year-old woman with bilateral subdural hematomas. Digital subtraction angiography showed obstruction of the sinus from the SSS to the right transverse sinus. Recanalization was achieved by selective thrombolysis using urokinase followed by balloon angioplasty, but re-occlusion occurred on the next day of treatment. Repeated endovascular treatment including balloon angioplasty, thrombus aspiration and thrombolysis using recombinant tissue plasminogen activator failed to achieve recanalization. We thus placed intracranial stents in the SSS, which did achieve recanalization. Case 2 was a 69-year-old woman with a small infarction in the left parietal lobe. Digital subtraction angiography showed sinus obliteration from the SSS to the bilateral transverse sinuses. Recanalization was not achieved by balloon angioplasty, thrombus aspiration and selective thrombolysis. We thus placed intracranial stents in the SSS, which did achieve recanalization. Postoperative course was uneventful in both cases and venous sinus patency was confirmed by venography >1.5 years after treatment. When conventional endovascular strategies have been unsuccessful, placement of intracranial stents, which can easily gain access to the distal part of the SSS as compared with carotid stents, may be a useful treatment option for the acute sinus thrombosis in this region.

scholarly journals Mechanical thrombectomy and intravascular imaging for cerebral venous sinus thrombosis: a preclinical model

2020 ◽  
pp. 1-6
Author(s):  
Christopher R. Pasarikovski ◽  
Jerry C. Ku ◽  
Julia Keith ◽  
Joel Ramjist ◽  
Yuta Dobashi ◽  
...  
Keyword(s):  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Preclinical Model ◽  
Endovascular Techniques ◽  
Venous Sinus Thrombosis ◽  
Cortical Vein ◽  
Sagittal Sinus ◽  
Oct Imaging

OBJECTIVEAlthough the majority of patients with cerebral venous sinus thrombosis (CVST) will improve with anticoagulation therapy, a portion of patients will either present in a comatose state or continue to deteriorate clinically despite early anticoagulation. In these cases, along with treating the underlying thrombophilia, timely thrombolysis may be beneficial. Repurposed arterial thrombectomy devices may not perform as expected in the cerebral venous sinus, and there are currently no preclinical endovascular thrombectomy (EVT) models for CVST. Contrary to arterial stroke research, preclinical models utilized to test various endovascular techniques and devices are lacking. The purpose of this research was to develop a reliable preclinical animal model for the testing of endovascular strategies to treat CVST.METHODSFive consecutive male Yorkshire swine weighing 45 kg were utilized. Thrombosis of the superior sagittal sinus was induced with a bovine thrombin injection via a microcatheter under distal balloon occlusion for 15 minutes. Combined arterial injections and superselective sinus injections confirmed the extent of thrombosis. EVT was subsequently performed using a second-generation stent retriever, followed by intravascular optical coherence tomography (OCT) imaging to assess the luminal environment after thrombectomy.RESULTSThrombosis of the superior sagittal sinus, EVT, and subsequent OCT imaging were technically successful in 4 of the 5 swine. Recanalization of the sinus with a second-generation stent retriever was successful after one attempt in 3 of 4 swine (75%), and 1 swine required two attempts. OCT imaging after thrombectomy revealed regions of residual sinus luminal thrombus despite complete angiographic recanalization. Thrombosed bridging cortical veins were also observed before draining into the sinus, along with patent cortical veins.CONCLUSIONSThe authors describe a preclinical model to assess endovascular techniques and devices for the treatment of CVST. Repurposed devices from arterial stroke may not perform as expected, given the unique features of venous sinus thrombosis. Residual bridging cortical vein thrombus and residual sinus thrombus, visualized on intravascular OCT, may be present despite complete sinus recanalization on angiography, and this may be the etiology of the poor clinical outcome despite technical success. In the setting of bridging cortical vein thrombus after successful sinus thrombectomy, direct chemical thrombolysis may be warranted to dissolve the remaining clot. This model may be helpful in developing and testing a new generation of devices designed specifically for CVST treatment.

scholarly journals Headache Patterns in Cerebral Venous Sinus Thrombosis

2017 ◽  
Vol 08 (S 01) ◽  
pp. S072-S077
Author(s):  
Ragasudha Botta ◽  
Sheshagiri Donirpathi ◽  
Ravi Yadav ◽  
Girish B. Kulkarni ◽  
M. Veerendra Kumar ◽  
...  
Keyword(s):  
Clinical Judgment ◽  
Sinus Thrombosis ◽  
Transverse Sinus ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Sagittal Sinus ◽  
Institutional Ethics ◽  
Headache Onset ◽  
The Mean

ABSTRACT Objectives: The objective of this study was to assess the clinical characteristics, patterns, and factors associated with headache in patients with cerebral venous sinus thrombosis (CVT). Methods: In this prospective cohort study, we recruited conscious CVT patients who were able to give reliable history after consent. Institutional ethics approval was obtained. The diagnosis of CVT was based on the clinical and imaging parameters. Data regarding headache characteristic, severity (visual analog scale [VAS]), imaging findings and outcome was recorded. Results: Forty-seven patients (19 males and 28 females) with mean age 29.7 ± 8.7 years were recruited. The mean duration of headache was 12.6 ± 26.8 days, and VAS was 79.38 ± 13.41. Headache onset was acute in 51.1%, subacute in 42.6%, thunderclap in 4.3%, and chronic in 2.1%; location was holocranial in 36.2%, frontal in 27.7% patients; description was throbbing in 44.7% and aching in 25.5% patients. Superior sagittal sinus and transverse sinus were involved in 63.8% cases each. The prothrombotic factors were anemia in 55.3%, puerperal in 38.3%, hyperhomocysteinemia in 29.8%, and polycythemia in 19.1%. Conclusion: Holocranial and bifrontal headache of increasing severity may be a marker of CVT. This may be useful in clinical judgment in identifying conscious patients with CVT.

scholarly journals Neurological recovery after coma related to diffuse cerebral venous sinus thrombosis. Interest in thrombi-aspiration with Penumbra system

2015 ◽  
Vol 21 (2) ◽  
pp. 218-221 ◽  
Author(s):  
Florent Gariel ◽  
Jerome Berge ◽  
Vincent Dousset
Keyword(s):  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Deep Coma ◽  
Venous Flow ◽  
Venous Sinus Thrombosis ◽  
Neurological Improvement ◽  
Sagittal Sinus ◽  
History Of

We report a young man with a history of deep coma secondary to an extensive superior sagittal sinus thrombosis despite full systemic anticoagulation. Endovascular treatment combining a 5 Max ACE reperfusion catheter (Penumbra) and Solitaire (Covidien) retrieval device permitted revascularization of the superior sagittal sinus with restoration of anterograde venous flow. This treatment led to the disappearance of cytotoxic edema on MRI and to a neurological improvement with a modified Rankin scale score of 2 after two months. Our experience shows that this technique provides a useful and safe tool after failure of anticoagulation in cerebral venous sinus thrombosis.

scholarly journals Prophylactic lumboperitoneal shunt in cases of cerebral venous sinus thrombosis with papilledema

2021 ◽  
Vol 8 (7) ◽  
pp. 2104
Author(s):  
Deepak Ranade ◽  
Bhagirath More ◽  
Dushyant Kashyap ◽  
Vybhav Raghu ◽  
Shobhit Chhabra
Keyword(s):  
Complete Resolution ◽  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Shunt Insertion ◽  
Venous Sinus Thrombosis ◽  
Cortical Vein ◽  
Sagittal Sinus ◽  
Cortical Vein Thrombosis

Background: Although the mainstay of cerebral venous sinus thrombosis treatment is medical, rarely surgical intervention is warranted. We aimed to determine the role of prophylactic lumbo-peritoneal (LP) shunt in cases of CVST with papilledema.Methods: This is a retrospective review of 70 cases of CVST managed between November 2019 to April 2020. Indications for surgical management included poor response to medical management and severe vision impairment.Results: The mean age of the patients included in the study was 39.44±4.76 years. The most common presenting complaint was headache (83%) and nausea/vomiting (69%). On examination, the common findings were papilledema (57%), blurred vision (31%), double vision (21%) and hemiparesis (11%). Two cases had sudden loss of vision, who underwent emergency LP shunt surgery. Of the 40 cases with papilledema, 8 had severe papilledema. Based on MRI venography, transverse sinus was involved in half of all patients, superior sagittal sinus was involved in 29% and 21% had both the sinuses involved, while 7% had cortical vein thrombosis. Anticoagulants was the first line of therapy for the patients. Papilledema was present in 40 cases, of which 10 showed complete resolution of symptoms, 15 cases had reduced severity of symptoms and symptoms persisted in rest of the 15 cases. The 10 cases who had complete resolution of symptoms included two patients who underwent LP shunt. There were no deaths.Conclusions: We recommend that a LP shunt insertion in a patient with severe papilledema with superior sagittal sinus thrombosis can prevent disease progress, preserve vision and facilitate re-canalisation.

scholarly journals The Investigation of the Diagnostic Values of the T2WI Sequence in Cerebral Venous Sinuses Thrombosis in Comparison With 3D MRV

2020 ◽  
Author(s):  
Ghazaleh Jamalipour Soufi ◽  
Ali Hekmatnia ◽  
Arezoo Shafieyoun ◽  
Mahdieh Afzali
Keyword(s):  
Magnetic Resonance ◽  
Predictive Value ◽  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
Sagittal Sinus ◽  
Transverse Sinuses ◽  
Subacute Thrombosis

Cerebral venous sinus thrombosis is an important pathology with various clinical symptoms. Early detection of thrombosis is very important for the improvement of the prognosis. The aim of this study was to calculate the diagnostic value of T2-weighted sequences of magnetic resonance imaging (MRI) in detecting subacute thrombosis. All patients that were suspected of having subacute cerebral venous sinus thrombosis and were referred to the emergency center of Kashani hospital (between September 2018 and September 2019) were entered into the study. Magnetic resonance venography (MRV) and T2-weighted MRI were accomplished for each patient. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of MRI using MRV as the reference method were calculated. A total of 630 patients were entered into the study. A positive subacute venous sinus thrombosis was detected in the MRV of 53 patients; consequently, the sensitivity of 60%, the specificity of 80%, the PPV of 21%, and the NPV of 96% were calculated. MRI was highly specific for detecting the subacute thrombosis of superior sagittal sinus, transverse sinuses, sigmoid sinuses, and straight sinus (specificity>94%). A substantial agreement was detected between MRI and MRV in distinguishing thrombosis of superior sagittal sinus, transverse sinuses, sigmoid sinuses, and straight sinus (kappa>0.6). T2-weighted MRI is a specific method in detecting cerebral venous sinus thrombosis. In a patient with signs of thrombosis in the T2-weighted sequence, additional workups are highly suggested to rule out the pathology.

Republished: Sinus thrombectomy for purulent cerebral venous sinus thrombosis utilizing a novel combination of the Trevo stent retriever and the Penumbra ACE aspiration catheter: the stent anchor with mobile aspiration technique

2015 ◽  
Vol 8 (6) ◽  
pp. e24-e24 ◽  
Author(s):  
Justin R Mascitelli ◽  
Margaret Pain ◽  
Hekmat K Zarzour ◽  
Peter Baxter ◽  
Saadi Ghatan ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Stent Retriever ◽  
Venous Sinus ◽  
Dramatic Improvement ◽  
Lower Extremity Weakness ◽  
Venous Sinus Thrombosis ◽  
Sagittal Sinus ◽  
Aspiration Technique ◽  
Intracranial Complications

Intracranial complications of sinusitis are rare but life threatening. We present a case of a 17-year-old woman with sinusitis who deteriorated over the course of 12 days from subdural empyema and global purulent cerebral venous sinus thrombosis. The patient was managed with surgery and mechanical thrombectomy utilizing a novel ‘stent anchor with mobile aspiration technique’, in which a Trevo stent retriever (Stryker) was anchored in the superior sagittal sinus (SSS) while a 5 MAX ACE reperfusion catheter (Penumbra) was passed back and forth from the SSS to the sigmoid sinus with resultant dramatic improvement in venous outflow. The patient was extubated on postoperative day 3 and was discharged with minimal lower extremity weakness on postoperative day 11. This is the first report using the Trevo stent retriever for sinus thrombosis. It is important to keep these rare complications in mind when evaluating patients with oral and facial infections.

Abstract 3070: Assessment of Manual Aspiration Therapy for the Treatment of Sinus Thrombosis

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Lance Bodily ◽  
Mouhammad Jumaa ◽  
Syed Zaidi ◽  
Tudor Jovin ◽  
Brian Jankowitz
Keyword(s):  
Sinus Thrombosis ◽  
Anticoagulation Therapy ◽  
Stable Condition ◽  
Standard Of Care ◽  
Mass Effect ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Motor Deficits ◽  
Aspiration Thrombectomy ◽  
Venous Sinus Thrombosis

Objective: While hydration and anticoagulation is typically the standard of care for cerebral venous sinus thrombosis, some patients remain refractory to medical management and continue to deteriorate. In these instances a number of more aggressive endovascular techniques have been reported to remove clots and restore blood flow in the venous sinuses. These techniques include direct thrombolysis, angioplasty, and various methods to disrupt and aspirate clot. Here we present the technique of endovascular transvenous manual aspiration thrombectomy (MAT) in five patients. Methods: We reviewed the records of five patients with medically refractory cerebral venous sinus thrombosis who received transvenous MAT. Presentation, technique, and outcome were evaluated. Results: Out of the five cases reviewed presentation included vomiting, dehydration, mental status changes, headaches, and acute motor deficits. On imaging three of the five patients had hemorrhage, edema, and mass effect present before treatment, while two had edema only. All of the patients reviewed were treated with anticoagulation therapy, intravenous heparin or subcutaneous lovenox, for a minimum of 24 hours. However, all of the patients continued to deteriorate despite early and aggressive medical anticoagulation therapy. All of the patients demonstrated rapid and progressive worsening of their neurological exam pre-operatively, including lack of arousal, pathological posturing, and expansion of secondary hemorrhages. This rapid deterioration warranted aggressive intervention, making the patients candidates for endovascular therapy. Direct thrombolysis with tPA was utilized with MAT via a distal access catheter(DAC) in all but one patient in which tPA was not used due to concern for hemorrhage. Aspiration of the superior sagittal sinus, transverse sinuses, straight sinus, and internal jugular were all included in this series. Catheters included the 0.070, 0.057, and 0.044 DAC and the 0.054 Penumbra microcatheter. Revascularization was achieved in all instances. One patient presented and remained neurologically devastated. She died 5 days after treatment. All other patients experienced improvement in their neurological examinations and were eventually discharged from the hospital in stable condition. Conclusions: Endovascular transvenous MAT is a feasible and effective revascularization technique to treat patients with cerebral venous sinus thrombosis.

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