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Proceedings SNO “Percorsi clinici in Neuroscienze”

Case report II SESSIONE
“STRATEGIE NEUROVASCOLARI”

Cerebral venous thrombosis:
early endovascular treatment

associated with medical therapy

A. GATTI*, A. MACERA**

* SC di Neurologia e Stroke Unit, Dipartimento di Neuroscienze,
ASST Grande Ospedale Metropolitano “Niguarda”, Milan, Italy
** SC di Neuroradiologia, Dipartimento di Neuroscienze, ASST Grande Ospedale Metropolitano “Niguarda”,
Milan, Italy

INTRODUCTION effective, leading to a high degree of successful re-
canalization rate of occluded dural sinus, so it may
Cerebral venous thrombosis accounts for 0.5-1% of represent an additional treatment in early stage of the
unselected stroke admission, and it primarily affects disease for selected patients with severe CVT, associ-
young adult and middleaged patients, mainly in ated with standard medical treatment.
women; its estimated incidence is of 1.32/100,000/ We describe two patients with severe CVT who un-
year in Western Europe. derwent to early endovascular treatment, with favor-
All major guidelines recommend anticoagulation able outcome.
with heparin as the standard treatment for CVT re-
gardless of the presence of an ICH. Despite heparin
treatment, however, approximately 15% of patients CASE REPORTS
has poor outcome (severe disability or death). Base-
line variables associated with an increased risk of ■ ■ Case 1. Female patient 84 years old was admitted

poor outcome include mental status disorder, coma to emergency room because of confusion, speech al-
state, ICH, and thrombosis of the deep venous sys- teration and right emiparesis. The symptoms onset at
tem. wake-up after a sleep of about 2 hours in the after-
In clinical practice, however, endovascular treatment noon. No previous illness was known and no medical
is increasingly being used to treat patients with CVT. therapy was chronically taken. NIHSS at the neurolo-
Heparin treatment predominantly prevents growth or gical evaluation was 12.
embolization of the existing thrombus, whereas EVT TC with arterious and venous imaging and perfusion-
aims to achieve rapid recanalization of the sinuses. al study was performed: recent ischemic lesions were
Only case reports or uncontrolled studies have evalu- detected in left cerebral hemisphere (temporal, occip-
ated the efficacy and safety of EVT in patients with ital, thalamus and internal capsula); deep cerebral
CVT; in these reports EVT seems feasible, safe, and veins, straight sinus, left transversus sinus, left sig-

Corrispondenza: Dr.ssa Antonella Gatti, SC di Neurologia e Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, piazza
Ospedale Maggiore 3, 20162 Milano (MI), tel. +39-(0)2-64442348, fax +39-(0)2-64442819, e-mail; antonella.gatti@ospedaleniguarda.it
Percorsi clinici in Neuroscienze. Clinical Round SIN e SNO Lombardia, 21 gennaio 2022, Desio (Monza e Brianza)
Atti a cura di Paolo Ferroli, Alessandra Protti, Andrea Salmaggi, Ignazio Michele Santilli, Luca Valvassori
Copyright © 2022 by new Magazine edizioni s.r.l., Trento, Italia. www.newmagazine.it ISBN: 978-88-8041-135-2

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