PMID- 32754364
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220416
IS  - 2229-5097 (Print)
IS  - 2152-7806 (Electronic)
IS  - 2152-7806 (Linking)
VI  - 11
DP  - 2020
TI  - Mechanical venous thrombectomy and prolonged infusion of tissue plasminogen 
      activator for cerebral venous sinus thrombosis: Video case report.
PG  - 193
LID - 10.25259/SNI_71_2020 [doi]
LID - 193
AB  - BACKGROUND: Cerebral venous sinus thrombosis (CVST) is a rare and often 
      misdiagnosed condition with mortality rates ranging from 6 to 10%. Diagnosis and 
      monitoring are typically achieved through noninvasive imaging, including computed 
      tomography or magnetic resonance venography. The current standard of treatment is 
      systemic anticoagulation. However, in patients who continue to decline 
      neurologically or do not show sufficient response to or have absolute 
      contraindications to systemic anticoagulation, endovascular treatments are an 
      alternative. Endovascular options are poorly studied and specific devices have 
      not been developed, partially due to the rare nature of the disease. Here, we 
      present a case report detailing the treatment of extensive CVST from the vein of 
      Galen to the sigmoid sinus using mechanical thrombectomy and local infusions of 
      unfractionated heparin (UFH) and tissue plasminogen activator. CASE DESCRIPTION: 
      A 53-year-old man presented and was found to have extensive CVST extending from 
      the vein of Galen to the left sigmoid sinus. Systemic UFH was begun; however, his 
      condition continued to decline, and he was taken for endovascular intervention, 
      wherein mechanical thrombectomy was undertaken using combinations of stent 
      retrievers and balloon catheters, which provided acceptable revascularization. 
      Unfortunately, his hospital course was further complicated by a cerebellar 
      hematoma that was surgically evacuated and reocclusion of the sinus for which a 
      microcatheter was placed for infusion of UFH and tissue plasminogen activator. 
      CONCLUSION: Complicated CVST may require aggressive endovascular management. 
      Local infusions of heparin and thrombolytic agents as well as mechanical 
      thrombectomy are safe alternative options.
CI  - Copyright: (c) 2020 Surgical Neurology International.
FAU - Housley, Steven B
AU  - Housley SB
AD  - Department of Neurosurgery, University at Buffalo, Buffalo, New York, United 
      States.
FAU - Vakharia, Kunal
AU  - Vakharia K
AD  - Department of Neurosurgery, University at Buffalo, Buffalo, New York, United 
      States.
FAU - Waqas, Muhammad
AU  - Waqas M
AD  - Department of Neurosurgery, University at Buffalo, Buffalo, New York, United 
      States.
FAU - Davies, Jason M
AU  - Davies JM
AD  - Department of Neurosurgery, University at Buffalo, Buffalo, New York, United 
      States.
FAU - Siddiqui, Adnan H
AU  - Siddiqui AH
AD  - Department of Neurosurgery, University at Buffalo, Buffalo, New York, United 
      States.
LA  - eng
GR  - KL2 TR001413/TR/NCATS NIH HHS/United States
PT  - Case Reports
DEP - 20200718
PL  - United States
TA  - Surg Neurol Int
JT  - Surgical neurology international
JID - 101535836
PMC - PMC7395561
OTO - NOTNLM
OT  - Cerebral venous sinus thrombosis
OT  - Endovascular therapy
OT  - Heparin
OT  - Mechanical venous thrombectomy
OT  - Tissue plasminogen activator
EDAT- 2020/08/06 06:00
MHDA- 2020/08/06 06:01
PMCR- 2020/07/18
CRDT- 2020/08/06 06:00
PHST- 2020/02/25 00:00 [received]
PHST- 2020/05/27 00:00 [accepted]
PHST- 2020/08/06 06:00 [entrez]
PHST- 2020/08/06 06:00 [pubmed]
PHST- 2020/08/06 06:01 [medline]
PHST- 2020/07/18 00:00 [pmc-release]
AID - SNI-11-193 [pii]
AID - 10.25259/SNI_71_2020 [doi]
PST - epublish
SO  - Surg Neurol Int. 2020 Jul 18;11:193. doi: 10.25259/SNI_71_2020. eCollection 2020.