Thrombolysis treatment with continuous urokinase infusion by placing the catheter in distal end of superior sagittal sinus for patients with intracranial venous sinus thrombosis: a report of nine cases

Abstract

Objective To evaluate the efficacy and safety of thrombolysis treatment with continuous urokinase infusion by placing the catheter in distal end of superior sagittal sinus for patients with intracraniai venous sinus thrombosis. Methods Nine patients with intracranial venous sinus thrombosis,admitted to our hospital from January 2008 to January 2011,were treated with continuous urokinase infusion by placing the catheter in distal end of superior sagittal sinus, assisting with mechanical thrombus maceration. The indication of stopping thrombolysis was that thrombolysis had been completely or mostly finished and the bole of obstructive cerebral sinus venous had been re-canalized. After the operation, treatments aimed at the primary diseases were continued and anti-platelet aggregation treatment was given for 6 months.The followed-up data were obtained at 9-30 months (averaged 20 months). The followed-up examinations were carried out once every 6 months,including lumbar puncture,fundus examination,and MRV or DSA. Results At discharge,all of the 9 patients achieved recanalization of cerebral venous sinuses.Arteriovenous circulation time was returned to normal; pallium vein and deep vein were put back. Clinical symptoms of all the patients were improved. Intracranial pressure recovered. Eyeground edema obviously lightened or disappeared.Glasgow coma scale (GCS) scores regained 15 points at discharge from an average of 10 points before thrombosis.No endovascular treatment-related complications were noted.During follow-up,no patients recurred. Conclusion Thrombolysis treatment with continuous urokinase infusion by placing the catheter in distal end of superior sagittal sinus is an effective and safe procedure for patients with intracranial venous sinus thrombosis. Key words: Thrombosis; Intracranial venous sinus; Superior sagittal sinus; Thrombolytic therapy; Urokinase