IMCC Team Successfully Treated an Indian Patient with Severe Cerebral Venous Sinus Thrombosis

Recently, an Indian patient with severe cerebral venous sinus thrombosis was successfully treated by team of IMCC in Shanghai No.1 general hospital. Experts applied mechanical embolectomy and thrombolytics. After hours of effort, this patient was saved.
This 48-year-old patient was transeferred to the emergency room in Shanghai No.1 general hospital on November 15th with presentation of acute headache and unstable blood pressure. Prior text shows the possibility of sagittal sinus thrombosis and the condition is seriously severe, experts decided to perform surgery on the next day after adequate discussion.

The next day, patient was performed sagittal sinus mechanical embolectomy and urokinase intravenous thrombolysis undergoing general anesthesia. During the operation, the patient was anesthetized and punctured into the right femoral vein and left femoral artery by Seldinger technique with 6F, 5F artery sheath in supine position. Cerebral angiography shows no obvious abnormalities of arterial system with decreased anastomotic vein and slow blood flow, no development of superior sagittal sinus, right lateral sinus and sigmoid sinus, and the time of cerebral circulation was extended. After ensuring the thrombosis, the guide catheter was placed into the left jugular vein and reached the left lateral sinus with the guide of micro-catheter and micro-wire. Then the micro-catheter was sent into the sagittal sinus. The micro-catheter super-selective angiography shows irregular development in sagittal sinus. With application of various sizes of balloon, sagittal sinus was expanded from distal to proximal side and large mixed embolus was removed, following with injection of 7.5 million units urokinase. Postoperative angiography presented patency of sagittal sinus and improvement of cerebral circulation. This surgery was totally successful. We monitored the coagulation function and other indications to prevent this patient from occurrence of hypertension and second bleeding. One week later, he was discharged from the hospital.

According to the literature, patients with cerebral venous sinus thrombosis are always in a severe situation. Mechanical embolectomy and thrombolysis is the best method of neurovascular interventions, which can quickly restore the brain circulation, improve the intracranial hypertension and save lives.