41 Venous Thrombectomy

Devi P. Patra, Evelyn L. Turcotte, Muriel T. Zaatar, Bernard R. Bendok, and Chandan Krishna

Abstract

Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke comprising only 0.5% of all strokes. The diagnosis is often challenging due to nonspecific symptoms including headache and seizure with subtle findings in initial computed tomography (CT) scans. Significant cerebral edemas in a nonarterial territory without obvious mass lesion and flame-shaped hemorrhages are initial findings that should raise suspicion of CVST. Early diagnosis and treatment are the key to prevent fatal complications due to malignant cerebral edema and herniation. Initiation of systemic anticoagulation is the first line of management to allow recanalization of the sinus and prevent clot progression. Endovascular therapy is reserved for nonimprovement of clinical symptoms or deterioration despite therapeutic anticoagulation. Catheter-based thrombolysis is the traditional method of treatment using urokinase or alteplase, which provides higher partial recanalization rates and better neurological outcome as compared to systemic anticoagulation alone. Other methods include mechanical thrombectomy using aspiration devices, rheolytic thrombectomy, stent retriever, balloon angioplasty, and aspiration. The overall radiological success rate (complete to partial recanalization) and clinical success rate (modified Rankin Score [mRS] of 0–2) described in the literature range from 70 to 95% and 75 to 85%, respectively, with acceptable complication rates of 3 to 5% (new or worsening hemorrhage).

Key words

venous sinus thrombosis - venous thrombectomy - venous thrombolysis - mechanical thrombectomy - cortical venous thrombosis

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