Intrasinus administering rt-PA combined with mechanical thrombectomy for serious cerebral venous sinus thrombosis

Abstract

Objective To investigate the effect of endovaseular interventional therapy, intrasinus administered recombinant tissue plasminogen activator(rt-PA) combined with mechanical thrombeetomy for serious cerebral venous sinus thrombosis(CVST). Method Eleven patients with serious CVST were accepted endovascular interventional therapy under general anaesthesia and systemic heparinization. Fifteen procedures were performed: rhcolytic thrombectomy with AngioJet catheter combined with intrasinus rt-PA thrombolysis in eight procedures, AngioJet catheter thrombectomy without intrasinus rt-PA thrombelysis in one procedure, and clot disruption with micro-balloon or micro-guidwire combined with intrasinus rt-PA thrombelysis in six procedures. Four of eleven patients were required a second endovascular interventional treatment for partial rethrombosis after the first procedure. Total rt-PA dose per procedure was ranged from 0 to 15 mg,mean (9. 4 ±4. 5)mg. All of the procedures were technically successful, no complications occurred. Results Eight patients were stupor or coma when they accepted therapy in our study, and two patients had transtentorial herniation. Eight of eleven patients experienced excellent or good clinical outcomes, and three patients died. The duration of follow-up ranged from 10 to 32 months(mean 21 months) ,MRI/MRV showed the affectedsinuses smoothly in six patients, partially smoothly in 2 patients. No patient has a rethrombesis. Conclusions The patient with serious CVST can be rapidly fatal only by routine therapy. Rhcolytic thrombectomy with AngioJet catheter or micro-balloon combined with intrsinus rt-PA thrombolysis can rapidly recanalize the affected dural sinuses in patients with CVST. It is a safe and effective endovascular method for high-risk patient with CVST. Key words: Venous thrombosis; Thrombolytic therapy; AngioJet catheter; rt-PA