A Series of Cerebral Venous Sinus Thromboses Treated with Intra-Arterial tPA infused over Ten Hours with a 0.027-inch Catheter and Literature Review.

Endrit Ziu,Muhammad Ibrahimi,O'Hara Haley,Scott Simon,Sara Langan

doi:10.7759/cureus.654

Abstract

Cerebral venous sinus thrombosis (CVST) can have devastating results, with mortality reported in 44% of cases. No randomized trials exist in order to define what qualifies as failure of conservative therapy, and there is no specific intervention to date which is considered safe and effective. Case series suggest that thrombolysis infusion is safer than thrombectomy, but methods of administration, dose, and duration of therapy tend to vary widely. We present three consecutive CVST patients treated with heparin who suffered both clinical and radiographic deterioration, and went on to have endovascular therapy. Each patient was successfully recanalized by placing a 0.027-inch microcatheter at the proximal portion of the thrombus and infusing 20 mg of alteplase dissolved in 1 liter of normal saline infused at 100 ml per hour for an infusion of 2 mg of alteplase per hour for ten hours.

Highlights

Cerebral venous sinus thrombosis (CVST) can have devastating results, with mortality reported in 44% of cases
We present three consecutive CVST patients treated with heparin who suffered both clinical and radiographic deterioration, and went on to have endovascular therapy
Each patient was successfully recanalized by placing a 0.027-inch microcatheter at the proximal portion of the thrombus and infusing 20 mg of alteplase dissolved in 1 liter of normal saline infused at 100 ml per hour for an infusion of 2 mg of alteplase per hour for ten hours

Summary

Introduction

Mortality and morbidity associated with cerebral venous sinus thrombosis (CVST) have been reported to be 10% and 44%, respectively [1]. A 0.027-inch microcatheter was placed in the thrombus in the sagittal sinus, and 20 mg of tPA was dissolved in a 1 liter bag of normal saline and infused at 2 mg/hr for ten hours. She was brought back to angiography at the completion of the infusion, which revealed recanalization (Figure 8). A CT scan revealed bilateral temporal venous infarcts and superior sagittal sinus, the straight sinus, vein of Galen, and the right transverse sinus (Figure 9). She was intubated for airway protection and started on heparin. The catheter tip and nonocclusive thrombus in the sinus are visible

Discussion

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Disclosures