Dandapat Sudeepta, Samaniego Edgar A, Szeder Viktor, Siddiqui Fazeel M, Duckwiler Gary R, Kiddy Ume, Guerrero Waldo R, Zheng Binbin, Hasan David, Derdeyn Colin, Ortega-Gutierrez Santiago
Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, IA, USA.
Department of Radiology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, IA, USA.
Interv Neuroradiol. 2020 Feb;26(1):26-32. doi: 10.1177/1591019919865957. Epub 2019 Jul 31.
Systemic anticoagulation is the standard treatment for cerebral venous sinus thrombosis (CVST). Several endovascular techniques have been described as salvage therapy for anticoagulation refractory CVST cases. We aim to evaluate the safety and feasibility of endovascular aspiration thrombectomy using the new generation, large bore suction catheters alone or in combination with stentriever devices for the treatment of CVST.
We collected data on 16 consecutive patients with CVST who received endovascular aspiration thrombectomy at three large academic centers. Second generation reperfusion catheters were used as a large bore suction catheter and advanced to the affected sinus using a coaxial technique. Suction was performed using pump suction. At times, a stentriever was used as an anchor to facilitate advancing the suction catheter and to increase thrombectomy capabilities.
Median decade of age was the 50s and nine patients were women. Fifty percent of the patients had multiple sinuses involved. All patients received systemic anticoagulation prior to endovascular aspiration thrombectomy. The most common reason to pursue endovascular aspiration thrombectomy in CVST patients was deterioration of initial clinical status (10/16). The mean time from admission to endovascular aspiration thrombectomy was 1.5 days (range 0-6 days). Good recanalization was obtained in all patients. There were no major peri-procedural complications. Most patients were discharged to either home or a rehabilitation facility.
Endovascular aspiration treatment using large bore suction catheters for CVST is a safe and feasible approach for the treatment of anticoagulation refractory CVST. Heterogeneity of the clinical and radiological presentation requires further investigation to optimize patient selection before evaluating the efficacy of this technique in larger prospective studies.
全身抗凝是脑静脉窦血栓形成（CVST）的标准治疗方法。已有多种血管内技术被描述为抗凝难治性CVST病例的挽救治疗方法。我们旨在评估单独使用新一代大口径抽吸导管或联合支架取栓装置进行血管内抽吸血栓切除术治疗CVST的安全性和可行性。
我们收集了在三个大型学术中心接受血管内抽吸血栓切除术的16例连续性CVST患者的数据。第二代再灌注导管用作大口径抽吸导管，并采用同轴技术推进至受累静脉窦。使用泵吸进行抽吸。有时，使用支架取栓器作为锚定物，以利于推进抽吸导管并提高血栓切除能力。
患者年龄中位数为50多岁，9例为女性。50%的患者累及多个静脉窦。所有患者在血管内抽吸血栓切除术之前均接受了全身抗凝治疗。CVST患者进行血管内抽吸血栓切除术的最常见原因是初始临床状态恶化（10/16）。从入院到血管内抽吸血栓切除术的平均时间为1.5天（范围0 - 6天）。所有患者均获得了良好的再通。围手术期无重大并发症。大多数患者出院回家或前往康复机构。
使用大口径抽吸导管对CVST进行血管内抽吸治疗是治疗抗凝难治性CVST的一种安全可行的方法。临床和影像学表现的异质性需要进一步研究，以便在更大规模的前瞻性研究中评估该技术的疗效之前优化患者选择。
