Endovascular treatment of cerebral venous sinus thrombosis: A case series

Özet

Objective: Anticoagulation theraphy is considered the standard therapy in the treatment of cerebral venous sinus thrombo- sis (CVST). However neurological condition may worsen during anticoagulation especially in cases with extensive thrombosis. Endovascular treatment options may be considered in these selected cases with clinical worsening or no improvement despite therapeutic anticoagulation. Methods: We retrospectively reviewed clinical and radiological findings of 11 CVST patients treated with endovascular meth- ods at our institution between July 2010 and February 2016 and the decision involved in endovascular treatment, methods of endovascular treatment and clinical outcomes were assessed. Results: The mean age of the patients (10 female, 1 male) was 28 years (17-45). All patients received intravenous heparin initial- ly. The most frequent indication requiring endovascular treatment was worsening or no improvement in mental status despite treatment. Mean Glasgow coma scale (GCS) score before endovascular treatment was 11.2±0.6. Balloon venoplasty was used in six patients, suction thrombectomy in five patients and stent-retriever thrombectomy in one. All patients received local intrasi- nus thrombolytic therapy with t-PA (5-40 mg). Clinical stabilization or rapid clinical improvement observed within 1-3 days of endovascular treatment in all patients. Patients’ mean GCS reverted to 15 at discharge. Discharge modified Rankin scale (mRS) scores were 1 in seven patients. Eight patients scored below 2 at one month and nine patients scored below 1 at long-term follow-up with a median duration of 28.4 months (6-48 months). Conclusion: Although no randomized controlled trials have yet been performed, endovascular treatment options may be con- sidered in cases with more severe clinical condition, with worsening or no improvement despite anticoagulation.