r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2021-26-5-24-29r-n-j-224Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯ И НАБЛЮДЕНИЯCLINICAL RESEARCH AND SURVEILLANCEЭндоваскулярное лечение церебрального венозного тромбозаEndovascular treatment of cerebral venous thrombosis.https://orcid.org/0000-0001-6061-8118КулешА. А.KuleshA. A.

Пермь

Perm

aleksey.kulesh@gmail.comКаракуловА. О.KarakulovA. O.

Пермь

Perm

artemii.karakulov@gmail.comФГБОУ ВО «Пермский государственный медицинский университет им. академика Е.А. Вагнера» Минздрава России; ГАУЗ ПК «Городская клиническая больница №4»РоссияPerm State Medical University named after Academician E.A. Wagner; City Clinical Hospital №4Russian FederationФГБОУ ВО «Пермский государственный медицинский университет им. академика Е.А. Вагнера» Минздрава РоссииРоссияPerm State Medical University named after Academician E.A. WagnerRussian Federation2021111120212652429Copyright © Кулеш А.А., Каракулов А.О., 20212021Кулеш А.А., Каракулов А.О.Kulesh A.A., Karakulov A.O.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/224

Представлено описание клинического наблюдения церебрального венозного тромбоза с вовлечением глубокой венозной системы у пациента, страдающего острым лимфобластным лейкозом. Так как состояние пациента прогрессивно ухудшалось несмотря на антикоагулянтную терапию, предпринята попытка эндоваскулярного лечения. Выполнены трансвенозная тромбэктомия и локальный тромболизис, что позволило достичь лишь частичной реканализации. Дальнейшее пролонгированное введение альтеплазы в церебральный синус через микрокатетер способствовало полной реканализации прямого и поперечных синусов. Восстановление кровотока сопровождалось регрессом неврологического дефицита. Данный случай обсуждается в контексте современных подходов к эндоваскулярному лечению церебрального венозного тромбоза.

The article describes a clinical case of cerebral venous thrombosis involving the deep venous system in a 42-year-old patient suffering from acute lymphoblastic leukemia. As the patient’s condition progressively deteriorated despite anticoagulant therapy, endovascular treatment was attempted. Transvenous thrombectomy and local thrombolysis were performed, which made it possible to achieve only partial recanalization. Further prolonged administration of alteplase into the cerebral sinus through a microcatheter facilitated complete recanalization of the direct and transverse sinuses. The restoration of blood flow was accompanied by regression of neurological deficit. This case is discussed in the context of modern approaches to endovascular treatment of cerebral venous thrombosis.

церебральный венозный тромбозтромбэктомиятромболизисcerebral venous thrombosisthrombectomythrombolysisReferencesPenailillo E., Bravo-Grau S., Plaza N., Cruz J.P. Cerebral Venous Thrombosis: Review of Diagnosis, Follow-Up, Late Complications and Potential Pitfalls. Curr. Probl. Diagn. Radiol. 2020;Aug 27:S0363-0188(20)30147-X. https://doi.org/10.1067/j.cpradiol.2020.08.007Penailillo E., Bravo-Grau S., Plaza N., Cruz J.P. Cerebral Venous Thrombosis: Review of Diagnosis, Follow-Up, Late Complications and Potential Pitfalls. Curr. Probl. Diagn. Radiol. 2020;Aug 27:S0363-0188(20)30147-X. https://doi.org/10.1067/j.cpradiol.2020.08.007Кулеш А.А., Нуриева Ю.А., Сыромятникова Л.И. Причины ишемического инсульта у пациентов моложе 45 лет: анализ данных регионального сосудистого центра. Неврология, нейропсихиатрия, психосоматика. 2021;13(1);24–30 https://doi.org/10.14412/2074-2711-2021-1-24-30Kulesh A.A., Nurieva Yu.A., Syromyatnikova L.I. Causes of ischemic stroke in patients younger than 45 years: analysis of data from the regional vascular center. Nevrologiya, neiropsikhiatriya, psikhosomatika (Neurology, Neuropsychiatry, Psychosomatics). 2021;13(1):24–30. (In Russ.). https://doi.org/10.14412/2074-2711-2021-1-24-30Ulivi L., Squitieri M., Cohen H., Cowley P., Werring D.J. Cerebral venous thrombosis: a practical guide. Pract. Neurol. 2020;20(5):356–367. https://doi.org/10.1136/practneurol-2019-002415. PMID: 32958591Ulivi L., Squitieri M., Cohen H., Cowley P., Werring D.J. Cerebral venous thrombosis: a practical guide. Pract. Neurol. 2020;20(5):356–367. https://doi.org/10.1136/practneurol-2019-002415. PMID: 32958591Ferro J.M., Canhão P., Stam J., Bousser M.G., 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(3):664–70. https://doi.org/10.1161/01.STR.0000117571.76197.26Ferro J.M., Canhão P., Stam J., Bousser M.G., 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(3):664–70. https://doi.org/10.1161/01.STR.0000117571.76197.26Medhi G., Parida S., Nicholson P., Senapati S.B., Padhy B.P., Pereira V.M. Mechanical Thrombectomy for Cerebral Venous Sinus Thrombosis: A Case Series and Technical Note. World Neurosurg. 2020;140:148–161. https://doi.org/10.1016/j.wneu.2020.04.220Medhi G., Parida S., Nicholson P., Senapati S.B., Padhy B.P., Pereira V.M. Mechanical Thrombectomy for Cerebral Venous Sinus Thrombosis: A Case Series and Technical Note. World Neurosurg. 2020;140:148–161. https://doi.org/10.1016/j.wneu.2020.04.220Ferro J.M., Aguiar de Sousa D. Cerebral Venous Thrombosis: an Update. Curr. Neurol. Neurosci. Rep. 2019;19(10):74. https://doi.org/10.1007/s11910-019-0988-xFerro J.M., Aguiar de Sousa D. Cerebral Venous Thrombosis: an Update. Curr. Neurol. Neurosci. Rep. 2019;19(10):74. https://doi.org/10.1007/s11910-019-0988-xScott J.A., Pascuzzi R.M., Hall P.V., Becker G.J. Treatment of dural sinus thrombosis with local urokinase infusion. Case report. J. Neurosurg. 1988;68:284–287. https://doi.org/10.3171/jns.1988.68.2.0284Scott J.A., Pascuzzi R.M., Hall P.V., Becker G.J. Treatment of dural sinus thrombosis with local urokinase infusion. Case report. J. Neurosurg. 1988;68:284–287. https://doi.org/10.3171/jns.1988.68.2.0284Siddiqui F.M., Dandapat S., Banerjee C., Zuurbier S.M., Johnson M., Stam J., Coutinho J.M. Mechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases. Stroke. 2015;46(5):1263–8. https://doi.org/10.1161/STROKEAHA.114.007465Siddiqui F.M., Dandapat S., Banerjee C., Zuurbier S.M., Johnson M., Stam J., Coutinho J.M. Mechanical thrombectomy in cerebral venous thrombosis: systematic review of 185 cases. Stroke. 2015;46(5):1263–8. https://doi.org/10.1161/STROKEAHA.114.007465lyas A., Chen C.J., Raper D.M., Ding D., Buell T., Mastorakos P. et al. Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis: a systematic review. J. Neurointerv. Surg. 2017;9(11):1086–1092. https://doi.org/10.1136/neurintsurg-2016-012938lyas A., Chen C.J., Raper D.M., Ding D., Buell T., Mastorakos P. et al. Endovascular mechanical thrombectomy for cerebral venous sinus thrombosis: a systematic review. J. Neurointerv. Surg. 2017;9(11):1086–1092. https://doi.org/10.1136/neurintsurg-2016-012938Coutinho J.M., Ferro J.M., Stam J. Endovascular Treatment for Cerebral Venous Thrombosis. World Neurosurg. 2020;144:194– 195. https://doi.org/10.1016/j.wneu.2020.09.119Coutinho J.M., Ferro J.M., Stam J. Endovascular Treatment for Cerebral Venous Thrombosis. World Neurosurg. 2020;144:194– 195. https://doi.org/10.1016/j.wneu.2020.09.119Ferro J.M., Bousser M.G., Canhão P., Coutinho J.M., Crassard I., Dentali F. et al. European Stroke Organization. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis — endorsed by the European Academy of Neurology. Eur. J. Neurol. 2017;24(10):1203–1213. https://doi.org/10.1111/ene.13381Ferro J.M., Bousser M.G., Canhão P., Coutinho J.M., Crassard I., Dentali F. et al. European Stroke Organization. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis — endorsed by the European Academy of Neurology. Eur. J. Neurol. 2017;24(10):1203–1213. https://doi.org/10.1111/ene.13381Andersen T.H., Hansen K., Truelsen T., Cronqvist M., Stavngaard T., Cortsen M.E. et al. Endovascular treatment for cerebral venous sinus thrombosis — a single center study. Br. J. Neurosurg. 2020;10:1–7. https://doi.org/10.1080/02688697.2020.1786498Andersen T.H., Hansen K., Truelsen T., Cronqvist M., Stavngaard T., Cortsen M.E. et al. Endovascular treatment for cerebral venous sinus thrombosis — a single center study. Br. J. Neurosurg. 2020;10:1–7. https://doi.org/10.1080/02688697.2020.1786498Coutinho J.M., Zuurbier S.M., Bousser M.G., Ji X., Canhão P., Roos Y.B. et al. TO-ACT investigators. Effect of Endovascular Treatment With Medical Management vs Standard Care on Severe Cerebral Venous Thrombosis: The TO-ACT Randomized Clinical Trial. JAMA Neurol. 2020;77(8):966–973. https://doi.org/10.1001/jamaneurol.2020.1022Coutinho J.M., Zuurbier S.M., Bousser M.G., Ji X., Canhão P., Roos Y.B. et al. TO-ACT investigators. Effect of Endovascular Treatment With Medical Management vs Standard Care on Severe Cerebral Venous Thrombosis: The TO-ACT Randomized Clinical Trial. JAMA Neurol. 2020;77(8):966–973. https://doi.org/10.1001/jamaneurol.2020.1022Sundar K., Paulraj S., Choudhury S.R., Hassan H., Sengupta J., Pattari S.K. Successful Endovascular Treatment of Cerebral Venous Thrombosis With a Novel, Larger Aspiration Catheter (REACT): A Case Report. Neurointervention. 2020;Dec 28. https://doi.org/10.5469/neuroint.2020.00304Sundar K., Paulraj S., Choudhury S.R., Hassan H., Sengupta J., Pattari S.K. Successful Endovascular Treatment of Cerebral Venous Thrombosis With a Novel, Larger Aspiration Catheter (REACT): A Case Report. Neurointervention. 2020;Dec 28. https://doi.org/10.5469/neuroint.2020.00304Yeo L.L., Lye P.P., Yee K.W., Cunli Y., Ming T.T., Ho A.F. et al. Deep Cerebral Venous Thrombosis Treatment : Endovascular Case using Aspiration and Review of the Various Treatment Modalities. Clin. Neuroradiol. 2020;30(4):661–670. https://doi.org/10.1007/s00062-020-00920-3Yeo L.L., Lye P.P., Yee K.W., Cunli Y., Ming T.T., Ho A.F. et al. Deep Cerebral Venous Thrombosis Treatment : Endovascular Case using Aspiration and Review of the Various Treatment Modalities. Clin. Neuroradiol. 2020;30(4):661–670. https://doi.org/10.1007/s00062-020-00920-3Wang Y., Zhao C., Huang D., Sun B., Wang Z. Stent retriever thrombectomy combined with long-term local thrombolysis for severe hemorrhagic cerebral venous sinus thrombosis. Exp. Ther. Med. 2020;20(5):66. https://doi.org/10.3892/etm.2020.9194Wang Y., Zhao C., Huang D., Sun B., Wang Z. Stent retriever thrombectomy combined with long-term local thrombolysis for severe hemorrhagic cerebral venous sinus thrombosis. Exp. Ther. Med. 2020;20(5):66. https://doi.org/10.3892/etm.2020.9194Housley S.B., Vakharia K., Waqas M., Davies J.M., Siddiqui A.H. Mechanical venous thrombectomy and prolonged infusion of tissue plasminogen activator for cerebral venous sinus thrombosis: Video case report. Surg. Neurol. Int. 2020;11:193. https://doi.org/10.25259/SNI_71_2020Housley S.B., Vakharia K., Waqas M., Davies J.M., Siddiqui A.H. Mechanical venous thrombectomy and prolonged infusion of tissue plasminogen activator for cerebral venous sinus thrombosis: Video case report. Surg. Neurol. Int. 2020;11:193. https://doi.org/10.25259/SNI_71_2020Sullinger D.P., Cho S.M., Farrokh S. Prolonged IntraSinus Alteplase Infusion in Severe Case of CVST. J. Pharm. Pract. 2020;Sep 14:897190020958260. https://doi.org/10.1177/0897190020958260Sullinger D.P., Cho S.M., Farrokh S. Prolonged IntraSinus Alteplase Infusion in Severe Case of CVST. J. Pharm. Pract. 2020;Sep 14:897190020958260. https://doi.org/10.1177/0897190020958260Qureshi A.I., Grigoryan M., Saleem M.A., Aytac E., Wallery S.S., Rodriguez G.J. et al. Prolonged Microcatheter-Based Local Thrombolytic Infusion as a Salvage Treatment After Failed Endovascular Treatment for Cerebral Venous Thrombosis: A Multicenter Experience. Neurocrit. Care. 2018;29(1):54–61. https://doi.org/10.1007/s12028-018-0502-3Qureshi A.I., Grigoryan M., Saleem M.A., Aytac E., Wallery S.S., Rodriguez G.J. et al. Prolonged Microcatheter-Based Local Thrombolytic Infusion as a Salvage Treatment After Failed Endovascular Treatment for Cerebral Venous Thrombosis: A Multicenter Experience. Neurocrit. Care. 2018;29(1):54–61. https://doi.org/10.1007/s12028-018-0502-3

The authors declare that there are no conflicts of interest present.