PMID- 32188921 OWN - NLM STAT- MEDLINE DCOM- 20201123 LR - 20210318 IS - 2045-2322 (Electronic) IS - 2045-2322 (Linking) VI - 10 IP - 1 DP - 2020 Mar 18 TI - Endovascular Mechanical Thrombectomy and On-Site Chemical Thrombolysis for Severe Cerebral Venous Sinus Thrombosis. PG - 4937 LID - 10.1038/s41598-020-61884-5 [doi] LID - 4937 AB - Cerebral venous sinus thrombosis (CVST) is a rare cause of cerebral infarction. Once patients survive the acute phase, long-term prognosis is generally satisfactory. CVST patients who harbored risk factors known for poor prognosis (e.g., deterioration of consciousness/neurological functions and seizures) were oftentimes unresponsive to systemic heparin treatment. The advantage of combined endovascular mechanical thrombectomy (EMT) and on-site chemical thrombolysis (OCT) plus systemic heparin for CVST over the heparin treatment alone has not been proved. A retrospective study was conducted to analyze consecutive patients with CVST from 2005 to 2015. Patients having clinical improvement or stable disease after heparin treatment were in I/S group; patients having continuous deterioration of consciousness/neurological functions and refractory seizures (despite the use of multiple anti-epileptic drugs) after heparin treatment were in D group. EMT and OCT were indicated for patients in D group. Imaging studies and medical records were reviewed for statistical analysis. Safety issues included new-onset/progression of symptomatic intracerebral hemorrhages (ICH) or procedure-related complications. Total thirty patients were included (I/S group = 16; D group = 14). In D group, the mean time frame from the start of heparin treatment to the endovascular treatment was 3.2 days. Compared with I/S group, all patients in D group had complete stenosis of the sinuses, with higher initial mRS, lower initial GCS, and more seizures (p = 0.006, 0.007, and 0.031, respectively), but no significant differences in the mRS at discharge (p = 0.504). Shorter length of thrombosis and lower initial mRS were associated with better outcomes (p = 0.009 and 0.003, respectively). Thrombosis involving the superior sagittal sinus (SSS) was associated with bad outcomes (p = 0.026). There were two patients (6.7%) with worsening symptomatic ICH, one in each group, managed surgically. The overall mortality of the study was 6.7% (2/30). Combined EMT and OCT after heparin treatment for severe CVST were reasonably safe, which might be considered as a salvage treatment in severe CVST patients who are unresponsive to heparin with heavy clot burden involving SSS in the acute phase. However, further studies are needed to confirm its efficacy and validity. FAU - Liao, Chih-Hsiang AU - Liao CH AUID- ORCID: 0000-0003-3459-1913 AD - Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. AD - Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan. AD - Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. FAU - Liao, Nien-Chen AU - Liao NC AD - Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan. FAU - Chen, Wen-Hsien AU - Chen WH AD - Division of Neuroradiology, Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan. FAU - Chen, Hung-Chieh AU - Chen HC AD - Division of Neuroradiology, Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan. AD - School of Medicine, National Yang-Ming University, Taipei, Taiwan. FAU - Shen, Chiung-Chyi AU - Shen CC AD - Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan. ccshen61093@gmail.com. AD - Department of Neurosurgery, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan. ccshen61093@gmail.com. AD - Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan. ccshen61093@gmail.com. AD - Basic Medical Education Center, Central Taiwan University of Science and Technology, Taichung, Taiwan. ccshen61093@gmail.com. FAU - Yang, Shun-Fa AU - Yang SF AUID- ORCID: 0000-0002-0365-7927 AD - Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. ysf@csmu.edu.tw. AD - Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan. ysf@csmu.edu.tw. FAU - Tsuei, Yuang-Seng AU - Tsuei YS AD - Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. astrocytoma2001@yahoo.com.tw. AD - Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan. astrocytoma2001@yahoo.com.tw. AD - Department of Neurosurgery, Tri-service General Hospital, National Defense Medical Center, Taipei, Taiwan. astrocytoma2001@yahoo.com.tw. LA - eng PT - Journal Article DEP - 20200318 PL - England TA - Sci Rep JT - Scientific reports JID - 101563288 RN - 0 (Fibrinolytic Agents) SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Algorithms MH - Combined Modality Therapy MH - Computed Tomography Angiography MH - Disease Management MH - Endovascular Procedures MH - Female MH - Fibrinolytic Agents/administration & dosage/adverse effects/*therapeutic use MH - Humans MH - Magnetic Resonance Imaging MH - Male MH - *Mechanical Thrombolysis/methods MH - Middle Aged MH - Retrospective Studies MH - Risk Factors MH - Severity of Illness Index MH - Sinus Thrombosis, Intracranial/diagnosis/*therapy MH - Stroke/diagnosis/etiology/therapy MH - Symptom Assessment MH - *Thrombectomy/methods MH - Treatment Outcome PMC - PMC7080812 COIS- All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. EDAT- 2020/03/20 06:00 MHDA- 2020/11/24 06:00 PMCR- 2020/03/18 CRDT- 2020/03/20 06:00 PHST- 2019/09/20 00:00 [received] PHST- 2020/02/28 00:00 [accepted] PHST- 2020/03/20 06:00 [entrez] PHST- 2020/03/20 06:00 [pubmed] PHST- 2020/11/24 06:00 [medline] PHST- 2020/03/18 00:00 [pmc-release] AID - 10.1038/s41598-020-61884-5 [pii] AID - 61884 [pii] AID - 10.1038/s41598-020-61884-5 [doi] PST - epublish SO - Sci Rep. 2020 Mar 18;10(1):4937. doi: 10.1038/s41598-020-61884-5.