Abstract Details

Title Successful Thrombolysis and Thrombectomy in a Patient with Extensive Cerebral Venous Thrombosis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P01 - (-)

Poster/Presentation
Number 239

Objective

Background BACKGROUND: Cerebral venous thrombosis may have a malignant clinical course, including parenchymal hemorrhage, severe neurological deficits, and deterioration despite therapeutic levels of anticoagulation. Baseline clinical and radiographic characteristics including impaired level of consciousness, focal neurological deficits, involvement of deep venous sinuses, and parenchymal abnormalities on MRI have been described as predictors of clinical deterioration and death.

Design/Methods DESIGN/METHODS: Case report.

Results RESULTS: A 62 year-old female presented with disorientation, abulia, and bilateral lower extremity weakness. CT scan showed hyperdensities in bilateral transverse sinuses. MRI+/- contrast confirmed thrombosis involving bilateral transverse sinuses extending into both internal jugular veins, superior sagittal sinus, and straight sinus. T2-weighted and FLAIR imaging revealed hyperintensities in bilateral parasagittal frontal lobes, without hemorrhage. Despite receiving 24 hours of intravenous heparin, she developed somnolence and worsening weakness. Catheter thrombolysis and thrombectomy was performed, consisting of catheter directed, combined thrombolysis (tPA) and suction thrombo-aspiration via a femoral transvenous approach. The superior sagittal sinus, straight sinus and bilateral transverse sinuses were successfully recanalized. The patient improved symptomatically immediately after intervention, and was discharged on dalteparin with a near-complete neurological recovery within 30 days.

Conclusions CONCLUSIONS: Due to extensive thrombosis, poor baseline characteristics and parenchymal changes suggestive of venous congestion on MRI, earlier intervention was pursued and yielded an excellent outcome. Early intervention with catheter thrombolysis and thrombectomy should be considered in patients with clinical and neuroimaging predictors of deterioration to reduce further complications of cerebral venous thrombosis.

Authors/Disclosures
Shazia Alam, DO PRESENTER	No disclosure on file
Ryna Then, MD (Jefferson Einstein Hospital)	Dr. Then has nothing to disclose.
	No disclosure on file
Kathryn F. Kirchoff, MD (Stern Stroke Center, Montefiore Medical Center)	Dr. Kirchoff has nothing to disclose.
Cindy Zadikoff, MD (AbbVie)	Dr. Zadikoff has received personal compensation for serving as an employee of AbbVie.

��ɫ��

��ɫ��