Document Detail


Endovascular thrombectomy and thrombolysis for severe cerebral sinus thrombosis: a prospective study.
MedLine Citation:
PMID:  18340091     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Jan Stam; Charles B L M Majoie; Otto M van Delden; Krijn P van Lienden; Jim A Reekers
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article     Date:  2008-03-13
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  39     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-04-29     Completed Date:  2008-05-29     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1487-90     Citation Subset:  IM    
Affiliation:
Department of Neurology, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. J.Stam@amc.uva.nl
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MeSH Terms
Descriptor/Qualifier:
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:
0/Fibrinolytic Agents; EC 3.4.21.73/Urokinase-Type Plasminogen Activator

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