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Mechanical thrombectomy versus intrasinus thrombolysis for cerebral venous sinus thrombosis: a non-randomized comparison.
Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.
  • Fazeel M. Siddiqui, University of Texas Southwestern Medical Center; Dallas, TX, USA
  • Chirantan Banerje, Medical Center; Dallas, TX, USA.
  • Susanna M. Zuurbier, University of Texas SouthwesternMedical Center; Dallas, TX, USA.
  • Qing Hao, University of California Los Angeles; Los Angeles, CA, USA.
  • Chul Ahn, University of Texas Southwestern Medical Center; Dallas, TX, USA.
  • Glenn L. Prid, University of Texas Southwester Medical Center; Dallas, TX, USA.
  • Mohammad Wasay, Aga Khan University
  • Charles B.L.M. . Majoie, University of Texas Southwester Medical Center; Dallas, TX, USA.
  • David Liebeskind, University of California Los Angeles; Los Angeles, CA, USA.
  • ,Mark Johnson, University of Texas Southwestern Medical Center; Dallas, TX, USA.
  • Jan Stam, Academic Medical Center, University of Amsterdam; Amsterdam, Netherlands.
Publication Date
5-1-2014
Document Type
Article
Abstract

Small retrospective studies have shown the benefit of endovascular treatment with intrasinus thrombolysis (IST) or mechanical thrombectomy (MT) with/without IST (MT ± IST) in cases of multifocal cerebral venous thrombosis (CVT). Our study compares the mortality, functional outcome and periprocedural complications among patients treated with MT ± IST versus IST alone. We reviewed clinical and angiographic findings of 63 patients with CVT who received endovascular treatment at three tertiary care centers. Primary outcome variables were discharge mortality and neurological dysfunction, and intermediate (three months) and long-term (>six months) morbidity. The modified Rankin scale (mRS) was used to assess morbidity. mRS ≤ 1 was considered a good recovery. Neurological dysfunction was rated as neuroscore: 0, normal; 1, mild (ambulatory, communicative); 2, moderate (non-ambulatory, communicative); and 3, severe (non-ambulatory, non-communicative/comatose). In patients who received IST alone, presenting neurological deficits were comparatively minor (p<0.001). When the two groups were adjusted for admission neuroscore, there was no statistical significance between discharge mortality [7(21%) versus 4(14%), p=0.228], neurological dysfunction (p=0.442), intermediate (p=0.336) and long-term morbidity (p=0.988). Patients who received MT ± IST had a higher percentage of periprocedural complications without reaching statistical significance. Compared to IST, MT was performed in severe cases with extensive sinus involvement. When adjusted for admission neurological dysfunction, both groups had similar mortality and discharge neurological dysfunction and similar intermediate and long-term morbidity.

Citation Information
Fazeel M. Siddiqui, Chirantan Banerje, Susanna M. Zuurbier, Qing Hao, et al.. "Mechanical thrombectomy versus intrasinus thrombolysis for cerebral venous sinus thrombosis: a non-randomized comparison." Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences. Vol. 20 Iss. 3 (2014) p. 336 - 344
Available at: http://works.bepress.com/mohammad_wasay/157/