Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Clinical Neuroradiology
Published in: Clinical Neuroradiology 4/2020

01-12-2020 | Venous Thrombosis | review article

Deep Cerebral Venous Thrombosis Treatment

Endovascular Case using Aspiration and Review of the Various Treatment Modalities

Authors: Leonard LL Yeo, Priscillia PS Lye, Kong Wan Yee, Yang Cunli, Tu Tian Ming, Andrew FW Ho, Vijay K Sharma, Bernard PL Chan, Benjamin YQ Tan, Anil Gopinathan

Published in: Clinical Neuroradiology | Issue 4/2020

Login to get access

Abstract

Background

Deep cerebral venous thrombosis (CVT) is an uncommon condition with a high morbidity and mortality. The optimal treatment approach for deep CVT remains uncertain and due to its low prevalence, randomized trials are not feasible. We showcase a straight sinus thrombosis treated with a large bore aspiration and performed a meta-analysis of the available literature to characterize and evaluate the various treatment modalities for patients with deep CVT.

Methods

We conducted a systematic search in PubMed, EMBASE and Ovid Medline using appropriate keywords/MESH terms search strategy. All patients with thrombosis involving the deep venous sinuses were included if treatment records were available. Outcome measures included recanalization of the affected sinus, good functional outcome assessed by a modified Rankin scale (mRS) of 0–2 or reported independent functional outcomes, permanent neurological deficits, further hemorrhage and mortality.

Results

A total of 69 studies comprising 120 patients were included in the analysis. Anticoagulation was the most common treatment (85.8%), whilst local intrasinus thrombolysis was performed in 40.0% of the patients and mechanical endovascular modalities were employed in 20.0% of the patients. Recanalization of the occluded sinus was seen in 83.5% of the patients while 62.6% patients achieved good functional outcome. There was considerable morbidity with 60.7% having a permanent neurological deficit, 23.3% having further hemorrhage after admission and 18.6% mortality. In the cohort receiving anticoagulation, 65.3% achieved good outcome but intracranial hemorrhage at presentation was associated with poorer outcome, permanent deficits, further bleeding and mortality.

Conclusion

Anticoagulation is an effective treatment strategy for deep CVT; however, patients with intracranial hemorrhage at presentation often have poorer outcomes and early endovascular strategies could be considered in this subgroup.
Appendix
Available only for authorised users
Literature
1.
Coutinho JM, Zuurbier SM, Stam J. Declining mortality in cerebral venous thrombosis: a systematic review. Stroke. 2014;45:1338–41.PubMedCrossRef
2.
Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F, ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the international study on cerebral vein and dural sinus thrombosis (ISCVT). Stroke. 2004;35:664–70.PubMedCrossRef
3.
Saposnik G, Barinagarrementeria F, Brown RD Jr, Bushnell CD, Cucchiara B, Cushman M, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American heart association/American stroke association. Stroke. 2011;42:1158–92.PubMedCrossRef
4.
Lee SK, Mokin M, Hetts SW, Fifi JT, Bousser MG, Fraser JF; Society of NeuroInterventional Surgery. Current endovascular strategies for cerebral venous thrombosis: report of the SNIS standards and guidelines committee. J Neurointervent Surg. 2018;10:803–10.CrossRef
5.
Ferro JM, Bousser MG, Canhão P, Coutinho JM, Crassard I, Dentali F, et al. European stroke organization guideline for the diagnosis and treatment of cerebral venous thrombosis—endorsed by the European academy of neurology. Eur Stroke J. 2017;2:195–221.PubMedPubMedCentralCrossRef
6.
Ferro JM, Aguiar de Sousa D. Cerebral venous thrombosis: an update. Curr Neurol Neurosci Rep. 2019;19:74.PubMedCrossRef
7.
Dandapat S, Samaniego EA, Szeder V, Siddiqui FM, Duckwiler GR, Kiddy U, et al. Safety and efficacy of the use of large bore intermediate suction catheters alone or in combination for the treatment of acute cerebral venous sinus thrombosis: a multicenter experience. Interv Neuroradiol. 2020;26:26–32.PubMedPubMedCentralCrossRef
8.
Pfefferkorn T, Crassard I, Linn J, Dichgans M, Boukobza M, Bousser MG. Clinical features, course and outcome in deep cerebral venous system thrombosis: an analysis of 32 cases. J Neurol. 2009;256:1839–45.PubMedCrossRef
9.
Borhani Haghighi A, Mahmoodi M, Edgell RC, Cruz-Flores S, Ghanaati H, et al. Mechanical thrombectomy for cerebral venous sinus thrombosis: a comprehensive literature review. Clin Appl Thromb Hemost. 2014;20:507–15.PubMedCrossRef
10.
Siddiqui FM, Dandapat S, Banerjee C, Zuurbier SM, Johnson M, Stam J, et al. Mechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases. Stroke. 2015;46:1263–8.PubMedCrossRef
11.
Siddiqui FM, Banerjee C, Zuurbier SM, Hao Q, Ahn C, Pride GL, et al. Mechanical thrombectomy versus intrasinus thrombolysis for cerebral venous sinus thrombosis: a non-randomized comparison. Interv Neuroradiol. 2014;20:336–44.PubMedPubMedCentralCrossRef
12.
Taniguchi S, Harada K, Kajihara M, Fukuyama K. Combined use of stent-retriever and aspiration thrombectomy for cerebral venous sinus thrombosis involving the straight sinus: a case report. Interv Neuroradiol. 2017;23:605–8.PubMedPubMedCentralCrossRef
13.
14.
Lewis W, Saber H, Sadeghi M, Rajah G, Narayanan S. Transvenous endovascular recanalization for cerebral venous thrombosis: a systematic review and meta-analysis. World Neurosurg. 2019;130:341–50.PubMedCrossRef
15.
Capecchi M, Abbattista M, Martinelli I. Cerebral venous sinus thrombosis. J Thromb Haemost. 2018;16:1918–31.PubMedCrossRef
16.
Tsang ACO, Hwang AC, Chiu RHY, Chan DYC, Tsang FCP, Ho WS, et al. Combined aspiration thrombectomy and continuous intrasinus thrombolysis for cerebral venous sinus thrombosis: technical note and case series. Neuroradiology. 2018;60:1093–6.PubMedCrossRef
17.
18.
Bhogal P, AlMatter M, Aguilar M, Nakagawa I, Ganslandt O, Bäzner H, et al. Cerebral venous sinus thrombosis: endovascular treatment with rheolysis and aspiration thrombectomy. Clin Neuroradiol. 2017;27:235–40.PubMedCrossRef
19.
Styczen H, Tsogkas I, Liman J, Maus V, Psychogios MN. Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis: a single-center experience. World Neurosurg. 2019;127:e1097–103.PubMedCrossRef
20.
İlgen U, Turan S, Emmungil H. Near-complete recanalization of jugular vein and multiple dural sinus thromboses with warfarin in a case of antiphospholipid syndrome. Reumatologia. 2018;56:406–8.PubMedPubMedCentralCrossRef
21.
Cakmak S, Derex L, Berruyer M, Nighoghossian N, Philippeau F, Adeleine P, et al. Cerebral venous thrombosis: clinical outcome and systematic screening of prothrombotic factors. Neurology. 2003;60:1175–8.PubMedCrossRef
22.
Bousser MG, Chiras J, Bories J, Castaigne P. Cerebral venous thrombosis—a review of 38 cases. Stroke. 1985;16:199–213.PubMedCrossRef
23.
Persson L, Lilja A. Extensive dural sinus thrombosis treated by surgical removal and local streptokinase infusion. Neurosurgery. 1990;26:117–20.PubMedCrossRef
24.
Scott JA, Pascuzzi RM, Hall PV, Becker GJ. Treatment of dural sinus thrombosis with local urokinase infusion. J Neurosurg. 1988;68:284–7.PubMedCrossRef
25.
26.
Philips MF, Bagley LJ, Sinson GP, Raps EC, Galetta SL, Zager EL, et al. Endovascular thrombolysis for symptomatic cerebral venous thrombosis. J Neurosurg. 1999;90:65–71.PubMedCrossRef
27.
Brown JI, Coyne TJ, Hurlbert RJ, Fehlings MG, Ter Brugge KG. Deep cerebral venous system thrombosis: case report. Neurosurgery. 1993;33:911–3.PubMed
28.
Crawford SC, Digre KB, Palmer CA, Bell DA, Osborn AG. Thrombosis of the deep venous drainage of the brain in adults. Analysis of seven cases with review of the literature. Arch Neurol. 1995;52:1101–8.PubMedCrossRef
29.
Haley EC Jr, Brashear HR, Barth JT, Cail WS, Kassell NF. Deep cerebral venous thrombosis. Clinical, neuroradiological, and neuropsychological correlates. Arch Neurol. 1989;46:337–40.PubMedCrossRef
30.
Forsting M, Krieger D, Seier U, Hacke W. Reversible bilateral thalamic lesions caused by primary internal cerebral vein thrombosis: a case report. J Neurol. 1989;236:484–6.PubMedCrossRef
31.
Erbguth F, Brenner P, Schuierer G, Druschky KF, Neundörfer B. Diagnosis and treatment of deep cerebral vein thrombosis. Neurosurg Rev. 1991;14:145–8.PubMedCrossRef
32.
Menon D, Sarojam MK, Gopal R. Unilateral thalamic infarct: a rare presentation of deep cerebral venous thrombosis. Ann Indian Acad Neurol. 2019;22:221–4.PubMedPubMedCentral
33.
Herrmann KA, Sporer B, Yousry TA. Thrombosis of the internal cerebral vein associated with transient unilateral thalamic edema: a case report and review of the literature. AJNR Am J Neuroradiol. 2004;25:1351–5.PubMedPubMedCentral
34.
Zheng H, Xu W, Chen Y, Gai S, Chen G. A rare case of deep cerebral venous thrombosis secondary to traumatic epidural hematoma: case report. Medicine (Baltimore). 2018;97:e11587.CrossRef
35.
Hsieh SW, Huang P, Lin HF, Lin WC, Hsu CY. Thrombosis of the vein of Galen: a case report. Acta Neurol Taiwan. 2007;16:234–7.PubMed
36.
Soda T, Edagawa K, Tsuji K, Dehara M, Nakajima Y, Ito M. Case of deep cerebral venous thrombosis associated with breast cancer. Rinsho Shinkeigaku. 2008;48:646–50.PubMedCrossRef
37.
Gladstone DJ, Silver FL, Willinsky RA, Tyndel FJ, Wennberg R. Deep cerebral venous thrombosis: an illustrative case with reversible diencephalic dysfunction. Can J Neurol Sci. 2001;28:159–62.PubMedCrossRef
38.
Murray BJ, Llinas R, Caplan LR, Scammell T, Pascual-Leone A. Cerebral deep venous thrombosis presenting as acute micrographia and hypophonia. Neurology. 2000;54:751-3.PubMedCrossRef
39.
Hsu LC, Lirng JF, Fuh JL, Wang SJ, Shyu HY, Liu HC. Proton magnetic resonance spectroscopy in deep cerebral venous thrombosis. Clin Neurol Neurosurg. 1998;100:27–30.PubMedCrossRef
40.
Horowitz M, Purdy P, Unwin H, Carstens G 3rd, Greenlee R, Hise J, et al. Treatment of dural sinus thrombosis using selective catheterization and urokinase. Ann Neurol. 1995;38:58–67.PubMedCrossRef
41.
42.
Hassan K, Kumar D. Reversible diencephalic dysfunction as presentation of deep cerebral venous thrombosis due to hyperhomocysteinemia and protein S deficiency: documentation of a case. J Neurosci Rural Pract. 2013;4:193.PubMedPubMedCentralCrossRef
43.
Frey JL, Muro GJ, McDougall CG, Dean BL, Jahnke HK. Cerebral venous thrombosis: combined intrathrombus rtPA and intravenous heparin. Stroke. 1999;30:489–94.PubMedCrossRef
44.
Nagatomo Y, Yanaka K, Kamezaki T, Kobayashi E, Matsumura A, Nose T. Recovery from primary deep cerebral venous sinus thrombosis with recanalisation. Neuroradiology. 1995;37:645–8.PubMedCrossRef
45.
Holmes FA, Obbens EA, Griffin E, Lee YY. Cerebral venous sinus thrombosis in a patient receiving adjuvant chemotherapy for stage II breast cancer through an implanted central venous catheter. Am J Clin Oncol. 1987;10:362–6.PubMedCrossRef
46.
Smith AG, Cornblath WT, Deveikis JP. Local thrombolytic therapy in deep cerebral venous thrombosis. Neurology. 1997;48:1613–9.PubMedCrossRef
47.
Griesemer DA, Theodorou AA, Berg RA, Spera TD. Local fibrinolysis in cerebral venous thrombosis. Pediatr Neurol. 1994;10:78–80.PubMedCrossRef
48.
Van Dyke DC, Eldadah MK, Bale JF Jr, Kramer M, Alexander R, Smith WL, et al. Mycoplasma pneumoniae-induced cerebral venous thrombosis treated with urokinase. Clin Pediatr. 1992;31:501–4.CrossRef
49.
Wang PY, Shen WC. MRI in internal cerebral vein thrombosis: case note. Neuroradiology. 1995;37:447–8.PubMedCrossRef
50.
Burneo JG, Elias SB, Barkley GL. Cerebral venous thrombosis due to protein S deficiency in pregnancy. Lancet. 2002;359:892.PubMedCrossRef
51.
Keller E, Flacke S, Urbach H, Schild HH. Diffusion- and perfusion-weighted magnetic resonance imaging in deep cerebral venous thrombosis. Stroke. 1999;30:1144–6.PubMedCrossRef
52.
Canhão P, Ferro JM, Lindgren AG, Bousser MG, Stam J, Barinagarrementeria F, et al. Causes and predictors of death in cerebral venous thrombosis. Stroke. 2005;36:1720–5.PubMedCrossRef
53.
Brucker AB, Vollert-Rogenhofer H, Wagner M, Stieglbauer K, Felber S, Trenkler J, et al. Heparin treatment in acute cerebral sinus venous thrombosis: a retrospective clinical and MR analysis of 42 cases. Cerebrovasc Dis. 1998;8:331–7.PubMedCrossRef
54.
Jaillard AS, Hommel M, Mallaret M. Venous sinus thrombosis associated with androgens in a healthy young man. Stroke. 1994;25:212–3.PubMedCrossRef
55.
Chaves C, Voetsch B, Loscalzo J, Caplan L, Chavali R. Extensive cerebral venous thrombosis associated with moderate hyperhomocystinemia and successfully treated with thrombolysis. Cerebrovasc Dis. 2002;13:214–6.PubMedCrossRef
56.
Holder CA, Bell DA, Lundell AL, Ulmer JL, Glazier SS. Isolated straight sinus and deep cerebral venous thrombosis: successful treatment with local infusion of urokinase. J Neurosurg. 1997;86:704–7.PubMedCrossRef
57.
Huh PW, Cho KS, Yoo DS, Kim JK, Kim DS, Kang JK. Deep cerebral venous thrombosis. Acta Neurochir (Wien). 2002;144:103–4; discussion 104-5.CrossRef
58.
Liebetrau M, Mayer TE, Bruning R, Opherk C, Hamann GF. Intra-arterial thrombolysis of complete deep cerebral venous thrombosis. Neurology. 2004;63:2444–5.PubMedCrossRef
59.
Akai T, Kuwayama N, Ogiichi T, Kurimoto M, Endo S, Takaku A. Leptomeningeal melanoma associated with straight sinus thrombosis—case report. Neurol Med Chir (Tokyo). 1997;37:757–61.CrossRef
60.
Rich C, Gill JC, Wernick S, Konkol RJ. An unusual cause of cerebral venous thrombosis in a four-year-old child. Stroke. 1993;24:603–5.PubMedCrossRef
61.
Buccino G, Scoditti U, Pini M, Menozzi R, Piazza P, Zuccoli P, et al. Loco-regional thrombolysis in the treatment of cerebral venous and sinus thrombosis: report of two cases. Acta Neurol Scand. 2001;103:59–63.PubMedCrossRef
62.
Gerszten PC, Welch WC, Spearman MP, Jungreis CA, Redner RL. Isolated deep cerebral venous thrombosis treated by direct endovascular thrombolysis. Surg Neurol. 1997;48:261–6.PubMedCrossRef
63.
Yamini B, Loch Macdonald R, Rosenblum J. Treatment of deep cerebral venous thrombosis by local infusion of tissue plasminogen activator. Surg Neurol. 2001;55:340–5.PubMedCrossRef
64.
Gurley MB, King TS, Tsai FY. Sigmoid sinus thrombosis associated with internal jugular venous occlusion: direct thrombolytic treatment. J Endovasc Surg. 1996;3:306–14.CrossRef
65.
van den Bergh WM, van der Schaaf I, van Gijn J. The spectrum of presentations of venous infarction caused by deep cerebral vein thrombosis. Neurology. 2005;65:192–6.PubMedCrossRef
66.
Rigamonti A, Carriero MR, Boncoraglio G, Leone M, Bussone G. Cerebral vein thrombosis and mild hyperhomocysteinemia: three new cases. Neurol Sci. 2002;23:225–7.PubMedCrossRef
67.
Pires A, Rocha S, Rodrigues M, Machado A, Lourenço E, Ferreira C. Deep cerebral venous thrombosis: a challenging diagnosis. Arq Neuropsiquiatr. 2011;69:563–5.PubMedCrossRef
68.
Topçuoglu MA. Complete resolution of thalamic lesion due to deep cerebral venous thrombosis. Intern Med J. 2010;40:84.PubMedCrossRef
69.
Taniguchi D, Nakajima S, Hayashida A, Kuroki T, Eguchi H, Machida Y, et al. Deep cerebral venous thrombosis mimicking influenza-associated acute necrotizing encephalopathy: a case report. J Med Case Rep. 2017;11:281.CrossRef
70.
Zhang A, Collinson RL, Hurst RW, Weigele JB. Rheolytic thrombectomy for cerebral sinus thrombosis. Neurocrit Care. 2008;9:17–26.PubMedCrossRef
71.
Opatowsky MJ, Morris PP, Regan JD, Mewborne JD, Wilson JA. Rapid thrombectomy of superior sagittal sinus and transverse sinus thrombosis with a rheolytic catheter device. AJNR Am J Neuroradiol. 1999;20:414–7.PubMedPubMedCentral
72.
Chow K, Gobin YP, Saver J, Kidwell C, Dong P, Viñuela F. Endovascular treatment of dural sinus thrombosis with rheolytic thrombectomy and intra-arterial thrombolysis. Stroke. 2000;31:1420–5.PubMedCrossRef
73.
Baker MD, Opatowsky MJ, Wilson JA, Glazier SS, Morris PP. Rheolytic catheter and thrombolysis of dural venous sinus thrombosis: a case series. Neurosurgery. 2001;48:487–93.PubMedCrossRef
74.
Agner C, Deshaies EM, Bernardini GL, Popp AJ, Boulos AS. Coronary AngioJet catheterization for the management of dural venous sinus thrombosis. J Neurosurg. 2005;103:368–71.PubMedCrossRef
75.
Heistinger M, Rumpl E, Illiasch H, Türck H, Kyrle PA, Lechner K, et al. Cerebral sinus thrombosis in a patient with hereditary protein S deficiency: case report and review of the literature. Ann Hematol. 1992;64:105–9.PubMedCrossRef
76.
Gomez CR, Misra VK, Terry JB, Tulyapronchote R, Campbell MS. Emergency endovascular treatment of cerebral sinus thrombosis with a rheolytic catheter device. J Neuroimaging. 2000;10:177–80.PubMedCrossRef
77.
Hauser D, Barzilai N, Zalish M, Oliver M, Pollack A. Bilateral papilledema with retinal hemorrhages in association with cerebral venous sinus thrombosis and paroxysmal nocturnal hemoglobinuria. Am J Ophthalmol. 1996;122:592–3.PubMedCrossRef
78.
Lin CC, Lui CC, Tain YL. Thalamic stroke secondary to straight sinus thrombosis in a nephrotic child. Pediatr Nephrol. 2002;17:184–6.PubMedCrossRef
79.
Kothare SV, Ebb DH, Rosenberger PB, Buonanno F, Schaefer PW, Krishnamoorthy KS. Acute confusion and mutism as a presentation of thalamic strokes secondary to deep cerebral venous thrombosis. J Child Neurol. 1998;13:300–3.PubMedCrossRef
80.
Chahlavi A, Steinmetz MP, Masaryk TJ, Rasmussen PA. A transcranial approach for direct mechanical thrombectomy of dural sinus thrombosis. Report of two cases. J Neurosurg. 2004;101:347–51.PubMedCrossRef
81.
Kirsch J, Rasmussen PA, Masaryk TJ, Perl J 2nd, Fiorella D. Adjunctive rheolytic thrombectomy for central venous sinus thrombosis: technical case report. Neurosurgery. 2007;60:E577–8.PubMedCrossRef
82.
Stam J, Majoie CB, van Delden OM, van Lienden KP, Reekers JA. Endovascular thrombectomy and thrombolysis for severe cerebral sinus thrombosis: a prospective study. Stroke. 2008;39:1487–90.PubMedCrossRef
83.
Kumar S, Rajshekher G, Reddy CR, Venkateswarlu J, Prabhakar S. Intrasinus thrombolysis in cerebral venous sinus thrombosis: single-center experience in 19 patients. Neurol India. 2010;58:225–9.PubMedCrossRef
Metadata
Title
Deep Cerebral Venous Thrombosis Treatment
Endovascular Case using Aspiration and Review of the Various Treatment Modalities
Authors
Leonard LL Yeo
Priscillia PS Lye
Kong Wan Yee
Yang Cunli
Tu Tian Ming
Andrew FW Ho
Vijay K Sharma
Bernard PL Chan
Benjamin YQ Tan
Anil Gopinathan
Publication date
01-12-2020
Publisher
Springer Berlin Heidelberg
Published in
Clinical Neuroradiology / Issue 4/2020
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-020-00920-3

Other articles of this Issue 4/2020

Clinical Neuroradiology 4/2020 Go to the issue

Original Article

Visualization of Aneurysm Healing

letter to the editor

Refining Intraoperative Angiography in the Prone Position

Original Article

Direct Admission vs. Secondary Transfer to a Comprehensive Stroke Center for Thrombectomy

Original Article

Flow Diversion for Treatment of Acutely Ruptured Intracranial Aneurysms

Original Article

High-Resolution MRI Vessel Wall Imaging in Acute Aneurysmal Subarachnoid Hemorrhage

Original Article

Recanalization is the Key for Better Outcome of Thrombectomy in Basilar Artery Occlusion