Abstract WP19: Safety and Validity of mechanical Thrombectomy and Thrombolysis on Severe Cerebral Venous Sinus Thrombosis

BACKGROUND: Although the vast majority of patients suffering from cerebral venous sinus thrombosis (CVST) obtain an optimistic clinical outcome after heparin or warfarin treatment, nevertheless, there remains a subgroup of patients that do not respond to the conventional anticoagulation treatment. These patients, especially the younger people as documented by hospital based studies, have a high morbidity and mortality rate. While the wide spectrum of clinical presentation in most CVST patients makes the diagnosis difficult at an earlier time, endovascular thrombolysis offers an aggressive option to treat CVST. OBJECTIVE: To verify the safety and validity of mechanical thrombectomy combined with thrombolysis in patients with severe CVST. METHODS: A total of 52 patients diagnosed with CVST from January 2007 to December 2010 were enrolled and treated with mechanical thrombectomy combined with thrombolysis. Patients underwent urokinase 100 ~1500×10 3 IU intravenous sinus injection via a jugular catheter after confirming CVST diagnoses by magnetic resonance imaging (MRI)/magnetic resonance venography (MRV) or digital subtraction angiography (DSA). Information obtained on the patients included recanalization status of venous sinuses as evaluated by MRV or DSA, at admission, during operation and 3 and 6 months follow-up after treatment. RESULTS: The percent of patients that showed complete and partial recanalization were 86% and 6% respectively after the mechanical thrombectomy combined with thrombolysis treatment, while 8% of the patients showed no recanilization. The modified Rankin Scale (mRS) scores were 1.0±0.9, 0.85±0.63 and 0.37±0.53 at discharge and at 3 and 6 months follow-up respectively. A total of 6 patients died despite receiving aggressive treatment. No relapsed cases were seen after 3 to 6 months of follow-up. CONCLUSION: Thrombectomy combined with thrombolysis is safe and valid to use in severe cases of CVST. However, a large scale multicenter clinical trial is warranted.