Role of mechanical thrombectomy in Sinus venous Thrombosis

11^th INTERNATIONAL CONFERENCE ON CENTRAL NERVOUS SYSTEM

April 27, 2022 | Webinar

Mohamed Elsharkawy

University Hospital Muenster, Germany

Posters & Accepted Abstracts: J Neurol Clin Neurosc

Abstract :

Cerebral venous sinus thrombosis (CVST) is a rather rare disease which accounts for <1% of all strokes. Diagnosis is still frequently overlooked or delayed because of the wide spectrum of clinical symptoms and the often subacute or lingering onset. Headache is the most frequent symptom of CVST and occurs in almost 90% of all cases. The headache may be of acute onset (thunderclap headache) and may be clinically indistinguishable from headache in patients with subarachnoid haemorrhage. Focal neurological signs (including focal seizures) are the most common finding in CVST. Heparin (unfractionated heparin or low-molecular-weight heparin) is the first-line treatment. Concomitant intracerebral hemorrhage related to CVST is not a contraindication to heparin therapy. Patient selection for thrombectomy is still not like in arterial Stroke. In CVST it depends on many factors like: Initial symptoms (for example coma, stupor) and if there is fast deterioration, length of the clots in CT/ MRI, and heparin non-responder. Early endovascular treatment is better than delaying intervention. There are many techniques including: stent retrieval thrombectomy, aspiration, catheter mediated maceration, balloon dilatation and Angiojet. In this Abstract we want to focus on our experience in combining the different recanalization techniques in the few cases that we treated. Recent publications 1. Liao, CH., Liao, NC., Chen, WH. et al. Endovascular Mechanical Thrombectomy and On-Site. Chemical Thrombolysis for Severe Cerebral Venous Sinus Thrombosis. Sci Rep 10, 4937 (2020). https://doi.org/10.1038/s41598-020-61884-5 2. Dashti SR, Hu YC, Yao T, et al. Mechanical thrombectomy as first-line treatment for venous sinus thrombosis: technical considerations and preliminary results using the AngioJet device. Journal of NeuroInterventional Surgery 2013; 5:49-53. 3. Einhäupl K, Stam J, Bousser MG, De Bruijn SF, Ferro JM, Martinelli I, Masuhr F; European Federation of Neurological Societies. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol. 2010 Oct;17(10):1229-35. doi: 10.1111/j.1468-1331.2010.03011.x. PMID: 20402748.