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LETTER TO THE EDITOR
Year : 2017  |  Volume : 20  |  Issue : 2  |  Page : 160-161
 

Direct mechanical thrombectomy with thromboaspiration in cerebral venous sinus thrombosis


Department of Interventional Neurology and Stroke, NH Institute of Neurosciences, Bengaluru, Karnataka, India

Date of Web Publication8-May-2017

Correspondence Address:
Vikram Huded
Department of Interventional Neurology and Stroke, NH Institute of Neurosciences, NH Health City, 258/A, Bommassandra Industrial Area, Hosur Road, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-2327.205767

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How to cite this article:
Bohra V, deSouza R, Karan V, Huded V. Direct mechanical thrombectomy with thromboaspiration in cerebral venous sinus thrombosis. Ann Indian Acad Neurol 2017;20:160-1

How to cite this URL:
Bohra V, deSouza R, Karan V, Huded V. Direct mechanical thrombectomy with thromboaspiration in cerebral venous sinus thrombosis. Ann Indian Acad Neurol [serial online] 2017 [cited 2019 Oct 20];20:160-1. Available from: http://www.annalsofian.org/text.asp?2017/20/2/160/205767


Sir,

Cerebral venous sinus thrombosis (CVT) accounts for 0.5%–1% of all stroke cases.[1] Stroke registry in India reported 1.22% of strokes to be due to CVT. It is commonly seen in young female in peripartum period.[2] The etiological factors include pregnancy, dehydration, use of oral contraceptive pills or other drugs, infections, prothrombotic states, hematological disorders, and connective tissue disorders.[1] Most common clinical features are headache and seizures.[3],[4] Diplopia, papilledema, and motor deficits such as mono or hemiparesis are frequent findings.[1] Systemic anticoagulation using conventional or low molecular weight heparin is the mainstay of treatment.[1] About 9%–13% of patients deteriorate on anticoagulation and direct catheter-guided thrombolysis or mechanical thrombectomy is preferred treatment modality in such cases.[1],[5]

A 25-year-old postpartum female and a 35-year-old female on treatment for polycystic ovarian disease, presented with recent onset headache followed by left hemiparesis. Second patient also had generalized tonic-clonic seizure. Both had superior sagittal sinus (SSS) thrombosis and were worsening on heparin, clinically as well as on imaging. As patients were worsening on anticoagulation, endovascular intervention was considered. After femoral venous access, 7F guiding catheter was negotiated into right internal jugular vein. Diagnostic venous angiogram confirmed venous sinus occlusion, 6F distal access catheter (DAC) catheter was negotiated into the sinus, maceration of clot was done with the same catheter and with to-and-fro movements of 035 Terumo wire followed by aspiration of clot. Postprocedure angiogram showed good recanalization of SSS in both [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d.
Figure 1: Patient 1 preaspiration venogram (a) showing nonopacification of mid and posterior third of superior sagittal sinus and postaspiration venogram, (b) showing recanalization of superior sagittal sinus. Patient 2 preaspiration venogram, (c) shows filling defect in mid-superior sagittal sinus and postaspiration venogram, (d) shows full recanalization. Both preaspiration venograms show prominent hanging veins and resolved in postaspiration images

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Both the patients had significant clinical improvement over the next 2–3 days and modified Rankin Scale at 3 months is 1.

We report two cases where emergent restoration of sinus patency was done with the use of DAC catheter only. In the process, we avoided the possible adverse effect that may arise out of use of urokinase as well as made the procedure cost-effective by reducing the use of additional device with equally effective outcome. To the best of our knowledge, this is first such report from the subcontinent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Saposnik G, Barinagarrementeria F, Brown RD Jr., Bushnell CD, Cucchiara B, Cushman M, et al. Diagnosis and management of cerebral venous thrombosis: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011;42:1158-92.  Back to cited text no. 1
    
2.
Mehndiratta MM, Garg S, Gurnani M. Cerebral venous thrombosis – clinical presentations. J Pak Med Assoc 2006;56:513-6.  Back to cited text no. 2
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3.
Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F; ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: Results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004;35:664-70.  Back to cited text no. 3
    
4.
Patil VC, Choraria K, Desai N, Agrawal S. Clinical profile and outcome of cerebral venous sinus thrombosis at tertiary care center. J Neurosci Rural Pract 2014;5:218-24.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Einhäupl K, Stam J, Bousser MG, De Bruijn SF, Ferro JM, Martinelli I, et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol 2010;17:1229-35.  Back to cited text no. 5
    


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