Mechanical thrombectomy with intra-operative local thrombolysis versus mechanical thrombectomy with continuous thrombolysis for treatment of cerebral venous sinus thrombosis: A Systematic Review of 82 Cases.

Mechanical thrombectomy with intra-operative local thrombolysis versus mechanical thrombectomy with continuous thrombolysis for treatment of cerebral venous sinus thrombosis: A Systematic Review of 82 Cases.

World Neurosurg. 2019 Jan 16;:

Authors: Chen C, Li X, Huang L, Chen S, Ye H, Ye Q, Zhang T, Zhang X, Zhang J, Chen Z, Yang C, Liang X

Abstract
OBJECT: The first-line treatment of Cerebral venous sinus thrombosis (CVST) is systemic anticoagulation. However, patients with severe or clinical worsening condition might benefit from mechanical thrombectomy (MT) combined intra-operative thrombolysis (IOT) or MT with continuous thrombolytic infusion (CTI). This study aimed to compare the efficacy and safety of these two endovascular therapeutic methods by performing a systematic review of literature.
METHODS: This systemic review was conducted to identify all cases of CVST performed with MT+IOT or MT+CTI/MT+IOT+CTI from PubMed and Ovid. Recanalization rates, outcome, operation-related complications, sequelae and postoperative hemorrhage were then evaluated.
RESULTS: A total of 28 studies, including 82 patients met the inclusion criteria. Alone MT+IOT was performed in 42 (51%) patients while MT+CTI/MT+IOT+CTI in 40 (49%) patients. Overall, data of outcome were available for 69 patients of which 57 (82%) patients had a good outcome, and 12 (18%) had a poor outcome or died. Data of recanalization were available for 68 patients. Among them, 28 (41%) patients had complete recanalization, 40 (59%) had partial, and no patient had no recanalization. Operation-related complications were reported in five (6%) patients while three of them (4%) occurred postoperative intracerebral hemorrhage. However, there was no significant difference between MT+IOT and MT+CTI/MT+IOT+CTI regarding recanalization and prognosis.
CONCLUSION: Our review suggests that MT with local thrombolysis is relatively safe and there is no significant difference between alone MT+IOT and MT+CTI/MT+IOT+CTI regarding efficacy and safety. But randomized controlled studies are required to provide a definitive answer on it's in patients with CVST.

PMID: 30659973 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2RBLnXj