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Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis

BACKGROUND: In dural venous sinus thrombosis (DVST), the mortality ranges 5–30%. Deep venous system involvement and septic dural sinus thrombosis have a higher mortality rate. In acute occlusion, collateral flow may not be established, which may result in significant edema and mass effect. Endovascu...

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Autores principales: Mammen, Suraj, Keshava, Shyamkumar Nidugala, Moses, Vinu, Aaron, Sanjith, Ahmed, Munawwar, Chiramel, George K, Mani, Sunithi E, Alexander, Mathew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385784/
https://www.ncbi.nlm.nih.gov/pubmed/28515593
http://dx.doi.org/10.4103/0971-3026.202956
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author Mammen, Suraj
Keshava, Shyamkumar Nidugala
Moses, Vinu
Aaron, Sanjith
Ahmed, Munawwar
Chiramel, George K
Mani, Sunithi E
Alexander, Mathew
author_facet Mammen, Suraj
Keshava, Shyamkumar Nidugala
Moses, Vinu
Aaron, Sanjith
Ahmed, Munawwar
Chiramel, George K
Mani, Sunithi E
Alexander, Mathew
author_sort Mammen, Suraj
collection PubMed
description BACKGROUND: In dural venous sinus thrombosis (DVST), the mortality ranges 5–30%. Deep venous system involvement and septic dural sinus thrombosis have a higher mortality rate. In acute occlusion, collateral flow may not be established, which may result in significant edema and mass effect. Endovascular interventions may be considered as a treatment option in appropriate high-risk patients with DVST. MATERIALS AND METHODS: Eight patients with magnetic resonance imaging (MRI)-confirmed dural sinus thrombosis, who did not respond to the conventional standard medical treatment, were subsequently treated with mechanical thrombectomy using the Penumbra System(®). In all cases, medical treatment including anticoagulants were continued following the procedure for a minimum period of 1 year. RESULTS: Recanalization of the dural sinus thrombosis was achieved in all 8 cases. There were no immediate or late endovascular-related complications. One death occurred due to an unrelated medical event. At 6 months, there was notable improvement in the modified Rankin Score (mRS), with 5/8 (62%) patients achieving mRS of 2 or less. The follow-up ranged between 3 months and 26 months (mean: 14.5 months), and there were no new neurological events during the follow-up period. CONCLUSION: Cerebral venous sinus thrombosis is a rare but life-threatening condition that demands timely diagnosis and therapy. In cases of rapidly declining neurological status despite standard therapy with systemic anticoagulation and anti-edema measures, mechanical thrombectomy could be a lifesaving and effective option. In this study, good outcomes were observed in the majority of patients at long-term follow up.
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spelling pubmed-53857842017-05-17 Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis Mammen, Suraj Keshava, Shyamkumar Nidugala Moses, Vinu Aaron, Sanjith Ahmed, Munawwar Chiramel, George K Mani, Sunithi E Alexander, Mathew Indian J Radiol Imaging Interventional Radiology BACKGROUND: In dural venous sinus thrombosis (DVST), the mortality ranges 5–30%. Deep venous system involvement and septic dural sinus thrombosis have a higher mortality rate. In acute occlusion, collateral flow may not be established, which may result in significant edema and mass effect. Endovascular interventions may be considered as a treatment option in appropriate high-risk patients with DVST. MATERIALS AND METHODS: Eight patients with magnetic resonance imaging (MRI)-confirmed dural sinus thrombosis, who did not respond to the conventional standard medical treatment, were subsequently treated with mechanical thrombectomy using the Penumbra System(®). In all cases, medical treatment including anticoagulants were continued following the procedure for a minimum period of 1 year. RESULTS: Recanalization of the dural sinus thrombosis was achieved in all 8 cases. There were no immediate or late endovascular-related complications. One death occurred due to an unrelated medical event. At 6 months, there was notable improvement in the modified Rankin Score (mRS), with 5/8 (62%) patients achieving mRS of 2 or less. The follow-up ranged between 3 months and 26 months (mean: 14.5 months), and there were no new neurological events during the follow-up period. CONCLUSION: Cerebral venous sinus thrombosis is a rare but life-threatening condition that demands timely diagnosis and therapy. In cases of rapidly declining neurological status despite standard therapy with systemic anticoagulation and anti-edema measures, mechanical thrombectomy could be a lifesaving and effective option. In this study, good outcomes were observed in the majority of patients at long-term follow up. Medknow Publications & Media Pvt Ltd 2017 /pmc/articles/PMC5385784/ /pubmed/28515593 http://dx.doi.org/10.4103/0971-3026.202956 Text en Copyright: © 2017 Indian Journal of Radiology and Imaging http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Interventional Radiology
Mammen, Suraj
Keshava, Shyamkumar Nidugala
Moses, Vinu
Aaron, Sanjith
Ahmed, Munawwar
Chiramel, George K
Mani, Sunithi E
Alexander, Mathew
Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis
title Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis
title_full Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis
title_fullStr Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis
title_full_unstemmed Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis
title_short Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis
title_sort role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis
topic Interventional Radiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385784/
https://www.ncbi.nlm.nih.gov/pubmed/28515593
http://dx.doi.org/10.4103/0971-3026.202956
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