| Endovascular thrombectomy and thrombolysis for severe cerebral sinus thrombosis: a prospective study. | |
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MedLine Citation:
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PMID: 18340091 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Most patients with cerebral sinus thrombosis (CST) recover after treatment with heparin, but a subgroup has a poor prognosis. Those patients may benefit from endovascular thrombolysis. METHODS: Prospective case series. Patients with sinus thrombosis were selected for thrombolysis if they had an altered mental status, coma, straight sinus thrombosis, or large space-occupying lesions. Urokinase was infused into the sinuses (bolus 120 to 600 x 10(3) U; then 100 x 10(3) U/h) via a jugular catheter, in 15 cases combined with mechanical thrombus disruption or removal. RESULTS: We treated 20 patients (16 women), mean age 32 years. Twelve patients were comatose and 14 had hemorrhagic infarcts before thrombolysis. Twelve patients recovered (Rankin score 0 to 2), 2 survived with handicaps, and 6 died. Factors associated with a fatal outcome were leukemia (3/6 versus 0/14, P=0.02) and large hemorrhagic infarcts (4/6 versus 2/14, P=0.04). Seizures were less frequent in the fatal cases (P=0.05). Patients who died had a larger mean lesion surface than survivors (30.5 versus 13.6 cm(2); P=0.03), larger midline shift (5.2 versus 1.7 mm; P=0.02), and a more rapid course (2.7 versus 8.2 days; P=0.01). Five patients who died had large hemispheric infarcts and edema before thrombolysis, causing herniation. Five patients had increased cerebral hemorrhage (3 minor, 2 major) after thrombolysis. CONCLUSIONS: Thrombolysis can be effective for severe sinus thrombosis, but patients may deteriorate because of increased cerebral hemorrhage. Patients with large infarcts and impending herniation did not benefit. |
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Authors:
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Jan Stam; Charles B L M Majoie; Otto M van Delden; Krijn P van Lienden; Jim A Reekers |
Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article Date: 2008-03-13 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 39 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2008 May |
Date Detail:
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Created Date: 2008-04-29 Completed Date: 2008-05-29 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 1487-90 Citation Subset: IM |
Affiliation:
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Department of Neurology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. J.Stam@amc.uva.nl |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Cerebral Hemorrhage / etiology, pathology, physiopathology Cerebral Infarction / complications, pathology, physiopathology Cranial Sinuses / drug effects, pathology, surgery Female Fibrinolytic Agents / administration & dosage Humans Male Patient Selection Postoperative Complications / etiology, pathology, physiopathology Prospective Studies Risk Assessment Risk Factors Sinus Thrombosis, Intracranial / drug therapy*, physiopathology, surgery* Thrombolytic Therapy / methods*, mortality, statistics & numerical data Treatment Outcome Urokinase-Type Plasminogen Activator / administration & dosage* Vascular Surgical Procedures / adverse effects, methods*, mortality |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; EC 3.4.21.73/Urokinase-Type Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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