DIRECT ENDOVASCULAR THROMBOLYTIC THERAPY FOR DURAL SINUS THROMBOSIS -INFUSION OF ALTEPLASE

PURPOSE: To evaluate the efficacy, safety, and results of direct throm bolytic therapy in intracranial dural sinus thrombosis by infusion of alteplase (recombinant tissue plasminogen activator). METHODS: Nine pa tients were treated during a 2-year period for intracranial dural sinu s thrombosis. A microcatheter was placed directly into the thrombus in the dural sinus via the transfemoral route. Thrombolysis was initiate d with a rapid injection of 10 mg of alteplase over 10 minutes, follow ed in 3 hours by a continuous infusion of 50 mg, then a continuous inf usion at 5 mg per hour until complete thrombolysis or a total dose of 100 mg per day had been reached. Repeat thrombolysis was tried the fol lowing day if complete recanalization did not occur at 100 mg per day. RESULTS: Successful recanalization with improvement of symptoms was a chieved in all cases. Time required for complete thrombolysis was betw een 8 and 43 hours. The total dose of alteplase ranged from 50 to 300 mg. Complications of a small intrapelvic hemorrhage and oozing at a fe moral puncture site occurred in separate cases, but were not related t o the amount of infused alteplase. MR venograms obtained 1 to 4 weeks after the procedure showed no evidence of reocclusion of the dural sin uses. CONCLUSION: Direct fibrinolytic therapy with alteplase is safe, fast, and effective in treating dural sinus thrombosis. However, to pr event hemorrhagic complications, further studies are required to deter mine its optimal dose and proper rate of administration.