Department of Neurological Surgery, UPMC, Pittsburgh, Pennsylvania, USA.
J Neurointerv Surg. 2013 Nov;5(6):534-8. doi: 10.1136/neurintsurg-2012-010476. Epub 2012 Sep 19.
Hydration and anticoagulation are the standard of care for cerebral venous sinus thrombosis (CVST) but some patients remain refractory to medical management and warrant more aggressive therapy. Here we present the technique of endovascular transvenous manual aspiration thrombectomy (MAT) in six patients.
Present an alternative technique for endovascular transvenous thrombectomy in a series of CVST patients.
We reviewed the records of six patients with medically refractory CVST. Transvenous access via the femoral vein was used to advance an aspiration catheter of varying internal diameter (0.044, 0.054, 0.057, 0.070, 0.072) up to and through the thrombus. Tissue plasminogen activator was administered in select cases. Manual aspiration with a 20 ml syringe applied to the catheter hub was applied as the catheter was slowly retracted. Presentation, technique, and outcome were evaluated.
Clinical presentation included vomiting, dehydration, mental status changes, headaches, and acute motor deficits. On imaging, four of the six patients had hemorrhage, edema, and mass effect present before treatment, while two had edema only. All patients demonstrated continued deterioration despite early and aggressive medical anticoagulation therapy, warranting aggressive intervention. Aspiration of the superior sagittal sinus, transverse sinuses, straight sinus, sigmoid sinus, and internal jugular vein were performed in this series. There were no procedural complications. Revascularization was achieved in all instances. A modified Rankin Scale score of 1-3 was attained in 5/6 patients, while one patient died.
In this series, transvenous MAT was a safe, simple, and effective revascularization technique to treat patients with CVST who remained refractory to medical management.
水化和抗凝是脑静脉窦血栓形成（CVST）的标准治疗方法，但有些患者对药物治疗仍有抵抗力，需要更积极的治疗。在此，我们介绍了 6 例经血管内经皮手动抽吸血栓切除术（MAT）的技术。
介绍 CVST 患者系列经血管内经皮血栓切除术的替代技术。
我们回顾了 6 例药物难治性 CVST 患者的记录。经股静脉经皮进入，将不同内径（0.044、0.054、0.057、0.070、0.072）的抽吸导管推进至血栓处并穿过血栓。在某些情况下给予组织型纤溶酶原激活剂。将 20ml 注射器应用于导管接头，在导管缓慢缩回时进行手动抽吸。评估了表现、技术和结果。
临床表现包括呕吐、脱水、精神状态改变、头痛和急性运动障碍。在影像学上，6 例患者中有 4 例在治疗前有出血、水肿和占位效应，而 2 例仅有水肿。尽管早期和积极的抗凝治疗，但所有患者均继续恶化，需要积极干预。在本系列中，对矢状窦上、横窦、直窦、乙状窦和颈内静脉进行了抽吸。无手术并发症。所有病例均实现了再通。6 例患者中有 5 例改良 Rankin 量表评分为 1-3 分，1 例患者死亡。
在本系列中，经血管内 MAT 是一种安全、简单、有效的血管再通技术，可治疗对药物治疗仍有抵抗力的 CVST 患者。
