Percutaneous Mechanical Thrombectomy for Acute Symptomatic Iliofemoral Deep Venous Thrombosis Patients With Recent Aneurysmal Subarachnoid Hemorrhage

Abstract

Purpose:

To investigate the efficacy, safety, and mid-term outcomes of percutaneous mechanical thrombectomy (PMT) for acute symptomatic iliofemoral deep venous thrombosis (DVT) patients with recent (within 4 weeks) aneurysmal subarachnoid hemorrhage (aSAH).

Materials and methods:

From January 2016 to February 2020, 11 acute symptomatic iliofemoral DVT patients with a recent history of aSAH were enrolled in this study. All patients had a history of aneurysm ligation or clipping previously, computed tomography (CT) scans revealed ventricular hemorrhage had been absorbed obviously and no residual aneurysm. The mean time of DVT onset after aSAH ictus was 19.2±4.5 days, and the mean Glasgow score was 6.8 ± 0.7 (range, 6–8). These patients underwent PMT with an 8 French Aspirex^®S device (Straub Medical AG, Wangs, Switzerland), subsequent stenting was performed to relieve the underlying stenosis, followed by anticoagulation alone. The procedure-related complications were assessed after intervention. The follow-ups were conducted up to 1 year, the patency was evaluated via duplex ultrasonography, and the incidence of post-thrombotic syndrome (PTS) was evaluated using the Villalta scale.

Results:

Grade III (>90%) clearance was achieved in all 11 patients. Stenting was performed in 7 patients (63.6%). There were no cerebral rebleeding events or other severe complications except 1 puncture site bleeding during treatment. A total of 90.9% (10 of 11) of patients were alive at the 12 month follow-up, and 7 patients achieved a good functional outcome. At the 1 year follow-up, there was 1 patient (10%) with mild PTS. The ultrasound showed that the patency of the iliofemoral veins was 100%, and femoral valvular incompetence was observed in 1 patient.

Conclusion:

Percutaneous mechanical thrombectomy seems to be a feasible and safe treatment for acute iliofemoral DVT in selected patients with recent aSAH, and it shows promising results in restoring patency and reducing the risk of PTS.

Keywords

percutaneous mechanical thrombectomy aneurysmal subarachnoid hemorrhage deep venous thrombosis safety efficacy

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References

Kshettry

Rosenbaum

Seicean

, et al. Incidence and risk factors associated with in-hospital venous thromboembolism after aneurysmal subarachnoid hemorrhage. J Clin Neurosci. 2014;21(2):282–286.

Serrone

Wash

Hartings

, et al. Venous thromboembolism in subarachnoid hemorrhage. World Neurosurgery. 2013;80(6):859–863.

Kim

Brophy

GM.

Symptomatic venous thromboembolism: incidence and risk factors in patients with spontaneous or traumatic intracranial hemorrhage. Neurocritical Care. 2009;11(1):28–33.

Mazzolai

Aboyans

Ageno

, et al. Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European Society of Cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function. European Heart Journal. 2018;39(47):4208–4218.

Meissner

Gloviczki

Comerota

, et al. Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2012;55(5):1449–1462.

Kearon

Akl

Ornelas

, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149(2):315–352.

Petridis

Kamp

Cornelius

, et al. Aneurysmal Subarachnoid Hemorrhage. Deutsches Arzteblatt International. 2017;114(13):226–236.

Eicker

Beseoglu

Etminan

, et al. The effect of intraventricular thrombolysis in combination with low-frequency head motion after severe subarachnoid hemorrhage: interim analysis of safety, clot clearance rate and delayed cerebral ischemia. Acta Neurochir Suppl. 2012;114:323–328.

Gaberel

Gakuba

Fournel

, et al. FIVHeMA: intraventricular fibrinolysis versus external ventricular drainage alone in aneurysmal subarachnoid hemorrhage: A randomized controlled trial. Neurochirurgie. 2019;65(1):14–19.

10.

Yoon

Lee

Kim

, et al. Preliminary study of tirofiban infusion in coil embolization of ruptured intracranial aneurysms. Neurosurgery. 2018;82(1):76–84.

11.

Zhu

Zhou

Chen

, et al. Percutaneous manual aspiration thrombectomy followed by stenting for iliac vein compression syndrome with secondary acute isolated iliofemoral deep vein thrombosis: a prospective study of single-session endovascular protocol. Eur J Vasc Endovasc Surg. 2014;47(1):68–74.

12.

Wang

Luo

, et al. Catheter-directed thrombolysis through anterior tibial vein for treating acute extensive deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2018;6(6):681–688.

13.

Cucuruz

Kopp

Pfister

, et al. Risk and protective factors for post-thrombotic syndrome after deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2020;8(3):390–395.

14.

Zeng

Zhang

Venous thromboembolism prevention during the acute phase of intracerebral hemorrhage. Journal of the Neurological Sciences. 2015;358(1–2):3–8.

15.

Klein

Howell

Straube

, et al. Rehabilitation outcome of patients with severe and prolonged disorders of consciousness after aneurysmal subarachnoid hemorrhage (aSAH). Clin Neurol Neurosurg. 2013;115(10):2136–2141.

16.

Takemoto

Hasegawa

Hashiguchi

, et al. Predictors for functional outcome in patients with aneurysmal subarachnoid hemorrhage who completed in-hospital rehabilitation in a single institution. J Stroke Cerebrovasc Dis. 2019;28(7):1943–1950.

17.

Witsch

Kuohn

Hebert

, et al. Early prognostication of 1-year outcome after subarachnoid hemorrhage: the FRESH score validation. J Stroke Cerebrovasc Dis. 2019;28(10):104280.

18.

Ironside

Buell

Chen

, et al. High-grade aneurysmal subarachnoid hemorrhage: predictors of functional outcome. World Neurosurg. 2019;125:e723–e728.

19.

Ianosi

Gaasch

Rass

, et al. Early thrombosis prophylaxis with enoxaparin is not associated with hematoma expansion in patients with spontaneous intracerebral hemorrhage. European Journal of Neurology. 2019;26(2):333–341.

20.

Sprügel

Sembill

Kuramatsu

, et al. Heparin for prophylaxis of venous thromboembolism in intracerebral haemorrhage. J Neurol Neurosurg Psychiatry. 2019;90(7):783–791.

21.

Hemphill

III Greenberg

Anderson

, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032–2060.

22.

Prabhakaran

Herbers

Khoury

, et al. Is prophylactic anticoagulation for deep venous thrombosis common practice after intracerebral hemorrhage. Stroke. 2015;46(2):369–375.

23.

Agnelli

Piovella

Buoncristiani

, et al. Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. The New England Journal of Medicine. 1998;339(2):80–85.

24.

Liang

Liu

, et al. Timing of deep vein thrombosis formation after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2015;123(4):891–896.

25.

Jaff

McMurtry

Archer

, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123(16):1788–1830.

26.

Zhao

Fan

Xiong

, et al. Aneurysm rebleeding after poor-grade aneurysmal subarachnoid hemorrhage: predictors and impact on clinical outcomes. Journal of the Neurological Sciences. 2016;371:62–66.

27.

Goyal

Tsivgoulis

Zand

, et al. Systemic thrombolysis in acute ischemic stroke patients with unruptured intracranial aneurysms. Neurology. 2015;85(17):1452–1458.

28.

Karthikesalingam

Young

Hinchliffe

, et al. A systematic review of percutaneous mechanical thrombectomy in the treatment of deep venous thrombosis. Eur J Vasc Endovasc Surg. 2011;41(4):554–565.

29.

Lin

Zhou

Dardik

, et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg. 2006;192(6):782–788.

30.

Wang

Sun

Chen

, et al. Meta-analysis and systematic review of percutaneous mechanical thrombectomy for lower extremity deep vein thrombosis. J Vasc Surg Venous Lymphat Disord. 2018;6(6):788–800.

31.

Loffroy

Falvo

Guillen

, et al. Single-session percutaneous mechanical thrombectomy using the Aspirex(®)S device plus stenting for acute iliofemoral deep vein thrombosis: safety, efficacy, and mid-term outcomes. Diagnostics (Basel, Switzerland). 2020;10(8).

32.

Köksoy

Yilmaz

Başbuğ

, et al. Pharmacomechanical thrombolysis of symptomatic acute and subacute deep vein thrombosis with a rotational thrombectomy device. J Vasc Interv Radiol. 2014;25(12):1895–1900.

33.

Stanley

Murphy

Plummer

, et al. Midterm results of percutaneous endovascular treatment for acute and chronic deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2013;1(1):52–58.

34.

Jiang

Jia

, et al. Incidence and outcomes of inferior vena cava filter thrombus during catheter-directed thrombolysis for proximal deep venous thrombosis. Ann Vasc Surg. 2017;38:305–309.