Treatment of deep cerebral venous thrombosis by local infusion of tissue plasminogen activator

BACKGROUND Treatment of extensive intracranial venous sinus thrombosis with thrombolyt ic drugs is described, although the indications for and most efficacious te chnique for achieving thrombolysis remain uncertain. We report the successf ul lysis of superficial and deep venous system thrombosis by infusion of re combinant human tissue-type plasminogen activator (rt-PA) into the anterior superior sagittal sinus. CASE DESCRIPTION A 34-year-old man presented with headaches followed by decreased level of c onsciousness and left hemiplegia. Angiography showed thrombosis of the supe rior sagittal and both transverse and straight sinuses with extension into the internal cerebral veins. The superior sagittal sinus was catheterized v ia a transfemoral route and rt-PA, 25 mg, was infused. There was no signifi cant change in the thrombosis. The catheter was left in place and rt-PA was infused at 1 mg/minute for 19 hours. Repeat angiography showed resolution of the thrombosis. The patient was placed on heparin and then coumadin. He recovered completely. CONCLUSIONS This report suggests that superselective infusion of thrombolytics into thr ombosed intracranial venous sinuses can lyse intracranial venous sinus thro mbosis. The thrombolytic agent must be infused for hours. The apparent succ essful lysis of clot in the deep venous system when infusion was into the s uperior sagittal sinus might be related to diffusion of rt-PA throughout th e intracranial venous system or to improved venous outflow caused by lysis of clot in superficial dural sinuses. (C) 2001 by Elsevier Science Inc.