• Adnan I Qureshi, Mikayel Grigoryan, Muhammad A Saleem, Emrah Aytac, Shawn S Wallery, Gustavo J Rodriguez, and Suri Muhammad F K MFK Zeenat Qureshi Stroke Institute, 519 2nd Street North, St. Cloud, MN, 56303, USA..
• Zeenat Qureshi Stroke Institute, 519 2nd Street North, St. Cloud, MN, 56303, USA.
• Neurocrit Care. 2018 Aug 1; 29 (1): 54-61.

Background And PurposeTo determine the effectiveness of prolonged microcatheter-based local thrombolytic infusion in treatment of patients with cerebral venous thrombosis who achieved no or suboptimal recanalization with transvenous endovascular treatment.MethodsData collection: Prospectively registries supplemented by retrospective review.SettingsThree hospitals with tertiary referral base.PatientsPatients who underwent transvenous endovascular treatment for cerebral venous thrombosis.InterventionProlonged microcatheter-based local thrombolytic infusion of alteplase at the rate of 0.5-1 mg/h in patients in whom initial angiographic outcome was deemed suboptimal, either due to incomplete or no recanalization.ResultsSerial angiograms were performed to assess treatment response as follows: grade I, partial recanalization of one or more occluded dural sinuses with improved flow or visualization of branches; grade II, complete recanalization of one sinus but persistent occlusion of the other sinuses (A-no residual flow, B-nonocclusive flow); grade III, complete recanalization. Clinical outcome was determined at 1-3 months using modified Rankin scale. A total of 14 patients underwent 15 transvenous endovascular treatments. Initial treatment was considered suboptimal in 12/15 procedures due to no recanalization in five (grade 0), partial recanalization (grade I) in four, complete recanalization of one sinus but persistent occlusion of the other sinuses (grade 2A in two and 2B in one). A prolonged microcatheter-based local recombinant tissue plasminogen activator infusion was used following ten of the 15 procedures for a median duration of 18 h (range 13-22 h). Follow-up angiography demonstrated complete recanalization in four procedures and improvement in grades of partial recanalization in six procedures (final grades 2A in three and 2B in three procedures). None of the patients developed new symptomatic intracranial hemorrhage associated with local thrombolytic infusion. At follow-up, patients in five of ten procedures had achieved a modified Rankin scale of 0 and one patient had achieved a score of 1 (no neurological deficits but had residual headaches).ConclusionProlonged microcatheter-based local thrombolytic infusion appeared to be effective treatment in patients who have suboptimal response to acute transvenous endovascular treatment without any additional adverse events.

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