Endovascular thrombolysis for pediatric cerebral sinus venous thrombosis with tissue plasminogen activator and abciximab

Case report

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  • 1 Departments of Neurosurgery and
  • 3 Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee; and
  • 2 Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Cerebral sinus venous thrombosis (CSVT) is a relatively rare but potentially devastating disease. Medical management of CSVT with systemic anticoagulation has been the mainstay treatment strategy with these patients. However, some patients may not respond to this treatment or may present with very severe symptoms indicating more aggressive management strategies. The authors present the case of a pediatric patient who presented with severe CSVT, who underwent successful recanalization with endovascular tissue plasminogen activator (tPA) and abciximab. To the authors' knowledge there are no cases of endovascular thrombolysis for CSVT described in the literature in which abciximab has been used in conjunction with tPA. The authors also review the literature regarding the agents used and outcome in pediatric patients with CSVT after endovascular thrombolysis. The use of abciximab in conjunction with tPA may be considered in patients whose blood is hypercoagulable and in whom the treatment strategy is to obtain acute recanalization and long-term venous patency. However, the use of adjunctive agents increases the risk of hemorrhagic complications and must be done judiciously.

Abbreviations used in this paper:CSVT = cerebral sinus venous thrombosis; ICH = intracerebral hemorrhage; SSS = superior sagittal sinus; SVG = saphenous vein graft; tPA = tissue plasminogen activator.

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Contributor Notes

Address correspondence to: Robert J. Singer, M.D., Neurovascular Therapeutics, Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756. email: rjsinger@mac.com.

Please include this information when citing this paper: published online November 1, 2013; DOI: 10.3171/2013.9.PEDS13335.

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