Q1 What is CVT?

CVT means thrombosis of major dural sinuses of brain.

Q2 What are indications for treating CVT?

All CVTs should be treated.

Q3 How to treat CVT?

CVT can be treated either by IV heparin or Insitu Thrombolysis.
Presence of intracerebral haemorrhage is not a contraindication for treatment.

Q4 What are advantages of Insitu Thrombolysis over IV heparin?

IV heparin is treatment of choice. However if patient GCS is < 9 or patient is not responding or worsening on heparin, he/she should be considered for Insitu Thrombolysis.

Q5 How Insitu Thrombolysis for CVT is done?

Step 1: Femoral vein is punctured and sheath is placed in femoral artery. Then through it guiding catheter (green) is placed into neck vein (Internal Jugular Vein).

Step 2: Then microcatheter (yellow) is taken through this guiding catheter in distal Superior Sagittal Sinus (SSS) and Thrombolytic drug (Urokinase) infusion started.

Step 3: As sinus open, micro catheter is withdrawn in proximal thrombus and infusion restarted. Gradually, complete opening of sinus is achieved.

Step 4: Finally microcatheter, guiding catheter and sheath are removed.

CASE: 30yrs female postpartum with Loss of Consciousness, CT scan showed CVT (Thrombosis in Superior Sagittal Sinus-SSS).