Safety and validity of mechanical thrombectomy and thrombolysis on severe cerebral venous sinus thrombosis.

Abstract BACKGROUND:: Although the majority of patients with cerebral venous sinus thrombosis (CVST) obtain an optimistic clinical outcome after heparin or warfarin treatment, there remains a subgroup of patients who do not respond to conventional anticoagulation treatment. These patients, especially younger people, as documented by hospital-based studies, have a high morbidity and mortality rate. OBJECTIVE:: To verify the safety and efficacy of a dual mechanical thrombectomy with thrombolysis treatment modality option in patients with severe CVST. METHODS:: 52 patients diagnosed as CVST were enrolled and treated with mechanical thrombectomy combined with thrombolysis. Patients underwent urokinase 100 ∼1500×10 IU intravenous sinus injection via a jugular catheter after confirming diagnoses of CVST using either MRI/MRV or DSA. Information obtained on the patients included recanalization status of venous sinuses as evaluated by MRV or DSA at admission, during operation, and at 3 and 6 months follow-up after treatment. RESULTS:: The percentage of patients that showed complete and partial recanalization were 87% and 6%, respectively, after mechanical thrombectomy combined with thrombolysis treatment; 8% of the patients showed no recanilization. The mRS scores were 1.0±0.9, 0.85±0.63, and 0.37±0.53 for discharge, and 3 and 6 month follow-up, respectively. A total of 6 patients died despite receiving aggressive treatment. No cases of relapse occurred after 3 to 6 months of follow-up. CONCLUSION:: Thrombectomy combined with thrombolysis is a safe and valid treatment modality to use in severe CVST cases or in intractable patients that have shown no adequate response to antithrombotic drugs.