Siddiqui F M, Pride G L, Lee J D
Department of Neurology, UT Southwestern Medical center; Dallas, TX, USA.
Interv Neuroradiol. 2012 Sep;18(3):314-9. doi: 10.1177/159101991201800311. Epub 2012 Sep 10.
Multifocal cerebral venous sinus thrombosis (CVST) has a high mortality rate especially when patients present with stupor or coma. Medical treatment including anticoagulation raises concerns about the associated high risk of intracerebral hemorrhage. Treatment of multifocal CVST with mechanical thrombectomy devices and local tPA infusion have previously been reported. However, these devices may have technical limitations. Success of the new-generation aspiration thrombectomy device like the Penumbra system has been reported in few cases of isolated CVST without the use of chemical thrombolysis. We describe two cases in which mechanical thrombectomy were used in conjunction with intra-sinus tPA infusion. Both cases were complicated and failed initial anticoagulation. Penumbra 054 was used in both cases. The Penumbra 054 is a novel device that has a bigger lumen which provides compatibility with other microcatheters, if additional therapies are required. The larger internal diameter of this catheter also allows for stronger thrombo-aspiration, potentially effecting more rapid sinus recanalization. Both cases showed remarkable clinical recovery without any major complications. This is the first reported simultaneous use of the Penumbra system 054 along with tPA infusion. New devices such as the Penumbra system may offer additional therapeutic options in the treatment of multifocal CVST.
多灶性脑静脉窦血栓形成（CVST）死亡率很高，尤其是当患者出现昏迷或昏睡时。包括抗凝治疗在内的药物治疗引发了对相关脑出血高风险的担忧。此前已有使用机械取栓装置和局部注射组织型纤溶酶原激活剂（tPA）治疗多灶性CVST的报道。然而，这些装置可能存在技术局限性。新一代抽吸式取栓装置如Penumbra系统在少数未使用化学溶栓的孤立性CVST病例中的成功应用已有报道。我们描述了两例联合使用机械取栓和静脉窦内注射tPA的病例。两例均病情复杂且初始抗凝治疗失败。两例均使用了Penumbra 054。Penumbra 054是一种新型装置，其管腔更大，若需要额外治疗，可与其他微导管兼容。该导管较大的内径还能实现更强的血栓抽吸，可能使静脉窦再通更快。两例均显示出显著的临床康复且无任何重大并发症。这是首次报道同时使用Penumbra系统054和tPA注射。诸如Penumbra系统等新装置可能为多灶性CVST的治疗提供更多治疗选择。
