Rheolytic catheter and thrombolysis of dural venous sinus thrombosis: A case series

OBJECTIVE: The high morbidity and mortality rates associated with dural sin us thrombosis may be heightened by a delay in diagnosis, which necessitates prompt and effective treatment. Traditional treatment consists of the init iation of systemic anticoagulation with heparin and, more recently, regiona l thrombolysis with direct endovascular infusion of thrombolytic agents. We report our experience in a series of five patients in whom we accomplished mechanical clot lysis with the combination of a rheolytic device and ballo on catheters. METHODS: five patients with dural sinus thrombosis were treated with a comb ination of pharmacological and mechanical thrombolysis with the 5-French An giojet rheolytic catheter (Possis Medical, Minneapolis, MN) and balloon cat heters. The success of the procedure was determined by resolution of or imp rovement in the patient's neurological examination results and imaging feat ures. RESULTS: All five patients demonstrated immediate improvement as observed o n imaging studies or in terms of neurological status. Three patients requir ed more than one intervention, and all but one patient continued to improve after the final intervention. Two of the five patients continued to experi ence mild residual neurological deficits, and two patients experienced comp lete recovery. The fifth patient had a delayed recurrence of thrombosis tha t required multiple interventions, and the patient has significant neurolog ical deficits. Navigation of the dural sinuses was possible in all patients with the use of a microcatheter and was possible to a variable degree with the rheolytic catheter, Known complications of the procedures included two pseudoaneurysms at the femoral puncture site. CONCLUSION: Mechanical clot lysis is a powerful technique for immediate res toration of antegrade venous flow in dural sinus thrombosis. In most patien ts, the superior sagittal sinuses and contralateral transverse sinuses coul d be accessed with the 5-French rheolytic catheter.