Endovascular thrombolysis for symptomatic cerebral venous thrombosis

Object. The authors sought to treat potentially catastrophic intracranial d ural and deep cerebral Venous thrombosis by using a multimodality endovascu lar approach. Methods. Six patients aged 14 to 75 years presented with progressive sympto ms of thrombotic intracranial venous occlusion. Five presented with neurolo gical deficits, and one patient had a progressive and intractable headache. All six had known risk factors for venous thrombosis: inflammatory bowel d isease (two patients), nephrotic syndrome (one), cancer (one), use of oral contraceptive pills (one), and puerperium (one). Four had combined dural an d deep venous thrombosis, whereas clot formation was limited to the dural v enous sinuses in two patients. All patients underwent diagnostic cerebral a rteriograms followed by transvenous catheterization and selective sinus and deep venous microcatheterization. Urokinase was delivered at the proximal aspect of the thrombus in dosages of 200,000 to 1,000,000 IU. In two patien ts with thrombus refractory to pharmacological thrombolytic treatment, mech anical wire microsnare maceration of the thrombus resulted in sinus patency . Radiological studies obtained 24 hours after thrombolysis reconfirmed sin us/vein patency in all patients. All patients' symptoms and neurological de ficits improved, and no procedural complications ensued. Follow-up periods ranged from 12 to 35 months: and all six patients remain free of any sympto matic venous reocclusion. Factors including patients' age, preexisting medi cal conditions, and duration of symptoms had no statistical bearing on the outcome. Conclusions. Patients with both dural and deep cerebral venous thrombosis o ften have a variable clinical course and an unpredictable neurological outc ome. With recent improvements in interventional techniques, endovascular th erapy is warranted in symptomatic patients early in the disease course, pri or to morbid and potentially fatal neurological deterioration.