Document Detail


Intrasinus catheter-directed heparin infusion in the treatment of dural venous sinus thrombosis.
MedLine Citation:
PMID:  19617450     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: In this small series, local intrasinus catheter-directed heparin infusion with or without balloon thrombectomy was safe in the treatment of dural venous sinus thrombosis (DVST). Although systemic anticoagulation (SAC) is the treatment of choice, there is a lack of consensus regarding the best treatment should SAC fail or be contraindicated. We present our institutional experience with 16 patients in whom failure of, or contraindication to, SAC occurred and who subsequently underwent intrasinus catheter-directed heparin infusion with or without balloon thrombectomy. MATERIALS AND METHODS: A retrospective review of 16 patients ranging in age from 14 days to 77 years who had intrasinus catheter-directed heparin infusion was undertaken with 9 male and 7 female patients identified. Of these 16 patients, 4 (25%) had a contraindication to SAC and SAC failed in 12 (75%). Technically successful intrasinus infusion catheter placement was achieved in all 16 patients (100%). Mean duration of infusion was 3.3 days (range, 1-6 days). Adjunctive balloon thrombectomy was performed in 9 (56.3%) of 16 patients. No procedure-related mortality occurred. RESULTS: Partial and complete sinus recanalization occurred in 10 (62.5%) of 16 patients and 1 (6.3%) of 16 patients, respectively. There were 3 deaths (18.8%) attributed to disease progression. At most recent clinical follow-up (mean, 9.3 months), 11 (84.6%) of 13 surviving patients were independent, with a modified Rankin Scale (mRS) score of 1 or less. CONCLUSIONS: Local intrasinus catheter-directed heparin infusion with or without adjunctive balloon thrombectomy seems to be a safe and effective treatment of DVST in patients in whom SAC failed or in whom there was a contraindication to SAC. In addition, the risk for symptomatic intracranial hemorrhage may be significantly lower than intrasinus infusion of thrombolytics.
Authors:
D V La Barge; F S Bishop; E A Stevens; R Eskandari; R H Schmidt; E J Skalabrin; P P Ng
Publication Detail:
Type:  Journal Article     Date:  2009-07-17
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  30     ISSN:  1936-959X     ISO Abbreviation:  AJNR Am J Neuroradiol     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-09     Completed Date:  2010-01-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1672-8     Citation Subset:  IM    
Affiliation:
Department of Radiology, Division of Neuroradiology, University of Utah, University Health Care, Salt Lake City, Utah 84132, USA. donald.labarge@hsc.utah.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Anticoagulants / administration & dosage*
Female
Heparin / administration & dosage*
Humans
Infusions, Parenteral
Male
Middle Aged
Retrospective Studies
Sinus Thrombosis, Intracranial / diagnosis*,  drug therapy*
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Anticoagulants; 9005-49-6/Heparin

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