Treatment of dural sinus thrombosis by urokinase infusion

T. P. Smith, R. T. Higashida, S. L. Barnwell, V. V. Halbach, C. F. Dowd, K. W. Fraser, G. P. Teitelbaum, G. B. Hieshima

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Abstract

PURPOSE: To gain a preliminary understanding of the role of thrombolytic therapy for the thrombosed dural sinus, we retrospectively reviewed our initial experience. METHODS: Seven patients, ages 25 to 71, who presented with symptomatic dural sinus thrombosis and who failed a trial of medical therapy were treated with direct infusion of urokinase into the thrombosed sinus. Patients received urokinase doses ranging from 20 000 to 150 000 U/h with a mean infusion time of 163 hours (range 88 to 244 hours). RESULTS: Patency of the affected dural sinus was achieved with antegrade flow in all patients. Six patients either improved neurologically over their prethrombolysis state or were healthy after thrombolysis; one of them required angioplasty. The other patient improved after surgical repair of a residual dural arteriovenous fistula. The only complications were an infected femoral access site which resolved after treatment with antibiotics and hematuria which cleared after discontinuation of anticoagulation. CONCLUSIONS: Thrombolysis of the thrombosed dural sinus shows promise as a safe and efficacious treatment. The results of this study should provide the impetus for further research.

Original languageEnglish (US)
Pages (from-to)801-807
Number of pages7
JournalAmerican Journal of Neuroradiology
Volume15
Issue number5
StatePublished - 1994
Externally publishedYes

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Intracranial Sinus Thrombosis
Urokinase-Type Plasminogen Activator
Central Nervous System Vascular Malformations
Therapeutics
Thrombolytic Therapy
Hematuria
Thigh
Angioplasty
Anti-Bacterial Agents
Research

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Smith, T. P., Higashida, R. T., Barnwell, S. L., Halbach, V. V., Dowd, C. F., Fraser, K. W., ... Hieshima, G. B. (1994). Treatment of dural sinus thrombosis by urokinase infusion. American Journal of Neuroradiology, 15(5), 801-807.

Treatment of dural sinus thrombosis by urokinase infusion. / Smith, T. P.; Higashida, R. T.; Barnwell, S. L.; Halbach, V. V.; Dowd, C. F.; Fraser, K. W.; Teitelbaum, G. P.; Hieshima, G. B.

In: American Journal of Neuroradiology, Vol. 15, No. 5, 1994, p. 801-807.

Research output: Contribution to journalArticle

Smith, TP, Higashida, RT, Barnwell, SL, Halbach, VV, Dowd, CF, Fraser, KW, Teitelbaum, GP & Hieshima, GB 1994, 'Treatment of dural sinus thrombosis by urokinase infusion', American Journal of Neuroradiology, vol. 15, no. 5, pp. 801-807.
Smith TP, Higashida RT, Barnwell SL, Halbach VV, Dowd CF, Fraser KW et al. Treatment of dural sinus thrombosis by urokinase infusion. American Journal of Neuroradiology. 1994;15(5):801-807.
Smith, T. P. ; Higashida, R. T. ; Barnwell, S. L. ; Halbach, V. V. ; Dowd, C. F. ; Fraser, K. W. ; Teitelbaum, G. P. ; Hieshima, G. B. / Treatment of dural sinus thrombosis by urokinase infusion. In: American Journal of Neuroradiology. 1994 ; Vol. 15, No. 5. pp. 801-807.
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AU - Higashida, R. T.

AU - Barnwell, S. L.

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AU - Dowd, C. F.

AU - Fraser, K. W.

AU - Teitelbaum, G. P.

AU - Hieshima, G. B.

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N2 - PURPOSE: To gain a preliminary understanding of the role of thrombolytic therapy for the thrombosed dural sinus, we retrospectively reviewed our initial experience. METHODS: Seven patients, ages 25 to 71, who presented with symptomatic dural sinus thrombosis and who failed a trial of medical therapy were treated with direct infusion of urokinase into the thrombosed sinus. Patients received urokinase doses ranging from 20 000 to 150 000 U/h with a mean infusion time of 163 hours (range 88 to 244 hours). RESULTS: Patency of the affected dural sinus was achieved with antegrade flow in all patients. Six patients either improved neurologically over their prethrombolysis state or were healthy after thrombolysis; one of them required angioplasty. The other patient improved after surgical repair of a residual dural arteriovenous fistula. The only complications were an infected femoral access site which resolved after treatment with antibiotics and hematuria which cleared after discontinuation of anticoagulation. CONCLUSIONS: Thrombolysis of the thrombosed dural sinus shows promise as a safe and efficacious treatment. The results of this study should provide the impetus for further research.

AB - PURPOSE: To gain a preliminary understanding of the role of thrombolytic therapy for the thrombosed dural sinus, we retrospectively reviewed our initial experience. METHODS: Seven patients, ages 25 to 71, who presented with symptomatic dural sinus thrombosis and who failed a trial of medical therapy were treated with direct infusion of urokinase into the thrombosed sinus. Patients received urokinase doses ranging from 20 000 to 150 000 U/h with a mean infusion time of 163 hours (range 88 to 244 hours). RESULTS: Patency of the affected dural sinus was achieved with antegrade flow in all patients. Six patients either improved neurologically over their prethrombolysis state or were healthy after thrombolysis; one of them required angioplasty. The other patient improved after surgical repair of a residual dural arteriovenous fistula. The only complications were an infected femoral access site which resolved after treatment with antibiotics and hematuria which cleared after discontinuation of anticoagulation. CONCLUSIONS: Thrombolysis of the thrombosed dural sinus shows promise as a safe and efficacious treatment. The results of this study should provide the impetus for further research.

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