Abstract 3213: Rheolytic Thrombectomy as First-line Treatment for Venous Sinus Thrombosis: Safety and Efficacy.

Abstract

BACKGROUND: Cerebral venous sinus thrombosis (CVT) is an uncommon cause of stroke. Current standard of care treatment is systemic anticoagulation. Although many patients make a good recovery on anticoagulation alone, others deteriorate due to intracranial venous hypertension, that may even lead to intracranial hemorrhage or death. Mechanical thrombectomy or intra-sinus thrombolytic therapy is often not successful in these patients because the damage is already too extensive by the time these therapies are initiated. OBJECTIVE: We present a series of patients with CVT who underwent rheolytic thrombectomy with the AngioJet (Possis Medical Inc., Minneapolis, MN) as a first-line treatment followed by standard anticoagulation therapy. METHODS: We retrospectively reviewed prospectively maintained endovascular database at two tertiary care referral centers. IRB approval was obtained at each institution. The available clinical and imaging data were compiled at each respective institution and analyzed in aggregate. RESULTS: Over 24 months, 14 patients (8 females, 6 men; age range 17-73 years, median age 44 years) with CVT were treated with rheolytic thrombectomy. Immediate (partial or complete) recanalization of the thrombosed intracranial sinuses was achieved in all patients. After the procedure, the clinical status of 11 patients (79%) improved significantly and that of one patient (7%) improved marginally. The average clinical follow-up was 12 months (range 3 to 16 months). Clinical and radiographic (computed tomography venography or magnetic resonance venography) follow-up was available for 8 patients, all of whom demonstrated patent sinuses and were symptom-free. There was one procedural complication (an asymptomatic perforation of a cerebellar vein) and no operative mortality. CONCLUSION: The mainstay of treatment for venous sinus thrombosis has been systemic anticoagulation therapy. More invasive endovascular approaches have been used only in a handful of cases as a last resort. We preliminary evidence in support of the efficacy and safety of mechanical rheolytic thrombectomy as a first-line treatment for acute CVT. In our series, this strategy promptly restored intracranial venous outflow with rapid symptomatic and neurological improvement in some patients.