The Experts below are selected from a list of 324 Experts worldwide ranked by ideXlab platform
Jan Stam - One of the best experts on this subject based on the ideXlab platform.
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endovascular thrombectomy and thrombolysis for severe Cerebral Sinus Thrombosis a prospective study
Stroke, 2008Co-Authors: Jan Stam, Charles B. L. M. Majoie, Otto M Van Delden, Krijn P Van Lienden, Jim A. ReekersAbstract:Background and purpose Most patients with Cerebral Sinus Thrombosis (CST) recover after treatment with heparin, but a subgroup has a poor prognosis. Those patients may benefit from endovascular thrombolysis. Methods Prospective case series. Patients with Sinus Thrombosis were selected for thrombolysis if they had an altered mental status, coma, straight Sinus Thrombosis, or large space-occupying lesions. Urokinase was infused into the Sinuses (bolus 120 to 600 x 10(3) U; then 100 x 10(3) U/h) via a jugular catheter, in 15 cases combined with mechanical thrombus disruption or removal. Results We treated 20 patients (16 women), mean age 32 years. Twelve patients were comatose and 14 had hemorrhagic infarcts before thrombolysis. Twelve patients recovered (Rankin score 0 to 2), 2 survived with handicaps, and 6 died. Factors associated with a fatal outcome were leukemia (3/6 versus 0/14, P=0.02) and large hemorrhagic infarcts (4/6 versus 2/14, P=0.04). Seizures were less frequent in the fatal cases (P=0.05). Patients who died had a larger mean lesion surface than survivors (30.5 versus 13.6 cm(2); P=0.03), larger midline shift (5.2 versus 1.7 mm; P=0.02), and a more rapid course (2.7 versus 8.2 days; P=0.01). Five patients who died had large hemispheric infarcts and edema before thrombolysis, causing herniation. Five patients had increased Cerebral hemorrhage (3 minor, 2 major) after thrombolysis. Conclusions Thrombolysis can be effective for severe Sinus Thrombosis, but patients may deteriorate because of increased Cerebral hemorrhage. Patients with large infarcts and impending herniation did not benefit.
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endovascular thrombectomy and thrombolysis for severe Cerebral Sinus Thrombosis a prospective study
Stroke, 2008Co-Authors: Jan Stam, Charles B. L. M. Majoie, Otto M Van Delden, Krijn P Van Lienden, Jim A. ReekersAbstract:Background and Purpose— Most patients with Cerebral Sinus Thrombosis (CST) recover after treatment with heparin, but a subgroup has a poor prognosis. Those patients may benefit from endovascular thrombolysis. Methods— Prospective case series. Patients with Sinus Thrombosis were selected for thrombolysis if they had an altered mental status, coma, straight Sinus Thrombosis, or large space-occupying lesions. Urokinase was infused into the Sinuses (bolus 120 to 600×103 U; then 100×103 U/h) via a jugular catheter, in 15 cases combined with mechanical thrombus disruption or removal. Results— We treated 20 patients (16 women), mean age 32 years. Twelve patients were comatose and 14 had hemorrhagic infarcts before thrombolysis. Twelve patients recovered (Rankin score 0 to 2), 2 survived with handicaps, and 6 died. Factors associated with a fatal outcome were leukemia (3/6 versus 0/14, P=0.02) and large hemorrhagic infarcts (4/6 versus 2/14, P=0.04). Seizures were less frequent in the fatal cases (P=0.05). Patien...
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anticoagulation for Cerebral Sinus Thrombosis
Stroke, 2003Co-Authors: Jan Stam, Sebastiaan F De Bruijn, Gabrielle DeveberAbstract:Treatment of Cerebral Sinus Thrombosis with anticoagulants has been controversial. Anticoagulants may prevent new venous infarcts, neurologic deterioration, and pulmonary embolism but may also promote hemorrhages. To review the available evidence regarding the effectiveness and safety of anticoagulant therapy in patients with confirmed Cerebral Sinus Thrombosis. We searched the Cochrane Stroke Group Trials Register (last searched March 18, 2002). We also searched MEDLINE (1966 to October 2001), EMBASE (1980 to February 2002), and the Cochrane Controlled Trials Register (Cochrane Library, 2002 Issue 1) and contacted authors to identify additional published and unpublished studies. Unconfounded randomized controlled trials in which anticoagulant therapy was compared with placebo or open control in patients with Cerebral Sinus Thrombosis (confirmed by intra-arterial contrast or magnetic resonance angiography). Two …
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The Cochrane Library - Anticoagulation for Cerebral Sinus Thrombosis
Stroke, 2003Co-Authors: Jan Stam, Sebastiaan F De Bruijn, Gabrielle DeveberAbstract:Treatment of Cerebral Sinus Thrombosis with anticoagulants has been controversial. Anticoagulants may prevent new venous infarcts, neurologic deterioration, and pulmonary embolism but may also promote hemorrhages. To review the available evidence regarding the effectiveness and safety of anticoagulant therapy in patients with confirmed Cerebral Sinus Thrombosis. We searched the Cochrane Stroke Group Trials Register (last searched March 18, 2002). We also searched MEDLINE (1966 to October 2001), EMBASE (1980 to February 2002), and the Cochrane Controlled Trials Register (Cochrane Library, 2002 Issue 1) and contacted authors to identify additional published and unpublished studies. Unconfounded randomized controlled trials in which anticoagulant therapy was compared with placebo or open control in patients with Cerebral Sinus Thrombosis (confirmed by intra-arterial contrast or magnetic resonance angiography). Two …
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Anticoagulation for Cerebral Sinus Thrombosis.
The Cochrane database of systematic reviews, 2002Co-Authors: Jan Stam, Sebastiaan F De Bruijn, Gabrielle DeveberAbstract:Background Treatment of Cerebral Sinus Thrombosis with anticoagulants has been controversial. Anticoagulants may prevent new venous infarcts, neurologic deterioration, and pulmonary embolism but may also promote haemorrhages. Objectives To review the available evidence regarding the effectiveness and safety of anticoagulant therapy in patients with confirmed Cerebral Sinus Thrombosis. Search strategy We searched the Cochrane Stroke Group Trials Register (last searched 18 March 2002). We also searched MEDLINE (1966-Oct 2001), EMBASE (1980-Feb 2002) and the Cochrane Controlled Trials Register (Cochrane Library, 2002 Issue 1) and contacted authors to identify additional published and unpublished studies. Selection criteria Unconfounded randomised controlled trials in which anticoagulant therapy was compared with placebo or open control in patients with Cerebral Sinus Thrombosis (confirmed by intra-arterial contrast or magnetic resonance angiography). Data collection and analysis Two reviewers independently extracted outcomes for each of the two treatment groups (anticoagulant treatment and control). The outcome data for each patient are analysed in the treatment group to which the patient was originally allocated ('intention to treat' analysis). A weighted estimate of the treatment effects across trials (relative risk, absolute risk reduction) is calculated using the Cochrane statistical software. Main results Two small trials involving 79 patients fulfilled the inclusion criteria. One trial (20 patients) examined the efficacy of intravenous, adjusted dose unfractionated heparin. The other trial (59 patients) examined high dose, body weight adjusted, subcutaneous, low-molecular weight heparin (Nadroparin). Anticoagulant therapy was associated with a pooled relative risk of death of 0.33 (95 % CI 0.08 to 1.21) and of death or dependency of 0.46 (95 % CI 0.16 to 1.31). No new symptomatic intraCerebral haemorrhages were observed. One major gastro-intestinal haemorrhage occurred after anticoagulant treatment. Two control patients (placebo) had a diagnosis of probable pulmonary embolism (one fatal). Reviewer's conclusions Based upon the limited evidence available, anticoagulant treatment for Cerebral Sinus Thrombosis appeared to be safe and was associated with a potentially important reduction in the risk of death or dependency which did not reach statistical significance.
Jim A. Reekers - One of the best experts on this subject based on the ideXlab platform.
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endovascular thrombectomy and thrombolysis for severe Cerebral Sinus Thrombosis a prospective study
Stroke, 2008Co-Authors: Jan Stam, Charles B. L. M. Majoie, Otto M Van Delden, Krijn P Van Lienden, Jim A. ReekersAbstract:Background and purpose Most patients with Cerebral Sinus Thrombosis (CST) recover after treatment with heparin, but a subgroup has a poor prognosis. Those patients may benefit from endovascular thrombolysis. Methods Prospective case series. Patients with Sinus Thrombosis were selected for thrombolysis if they had an altered mental status, coma, straight Sinus Thrombosis, or large space-occupying lesions. Urokinase was infused into the Sinuses (bolus 120 to 600 x 10(3) U; then 100 x 10(3) U/h) via a jugular catheter, in 15 cases combined with mechanical thrombus disruption or removal. Results We treated 20 patients (16 women), mean age 32 years. Twelve patients were comatose and 14 had hemorrhagic infarcts before thrombolysis. Twelve patients recovered (Rankin score 0 to 2), 2 survived with handicaps, and 6 died. Factors associated with a fatal outcome were leukemia (3/6 versus 0/14, P=0.02) and large hemorrhagic infarcts (4/6 versus 2/14, P=0.04). Seizures were less frequent in the fatal cases (P=0.05). Patients who died had a larger mean lesion surface than survivors (30.5 versus 13.6 cm(2); P=0.03), larger midline shift (5.2 versus 1.7 mm; P=0.02), and a more rapid course (2.7 versus 8.2 days; P=0.01). Five patients who died had large hemispheric infarcts and edema before thrombolysis, causing herniation. Five patients had increased Cerebral hemorrhage (3 minor, 2 major) after thrombolysis. Conclusions Thrombolysis can be effective for severe Sinus Thrombosis, but patients may deteriorate because of increased Cerebral hemorrhage. Patients with large infarcts and impending herniation did not benefit.
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endovascular thrombectomy and thrombolysis for severe Cerebral Sinus Thrombosis a prospective study
Stroke, 2008Co-Authors: Jan Stam, Charles B. L. M. Majoie, Otto M Van Delden, Krijn P Van Lienden, Jim A. ReekersAbstract:Background and Purpose— Most patients with Cerebral Sinus Thrombosis (CST) recover after treatment with heparin, but a subgroup has a poor prognosis. Those patients may benefit from endovascular thrombolysis. Methods— Prospective case series. Patients with Sinus Thrombosis were selected for thrombolysis if they had an altered mental status, coma, straight Sinus Thrombosis, or large space-occupying lesions. Urokinase was infused into the Sinuses (bolus 120 to 600×103 U; then 100×103 U/h) via a jugular catheter, in 15 cases combined with mechanical thrombus disruption or removal. Results— We treated 20 patients (16 women), mean age 32 years. Twelve patients were comatose and 14 had hemorrhagic infarcts before thrombolysis. Twelve patients recovered (Rankin score 0 to 2), 2 survived with handicaps, and 6 died. Factors associated with a fatal outcome were leukemia (3/6 versus 0/14, P=0.02) and large hemorrhagic infarcts (4/6 versus 2/14, P=0.04). Seizures were less frequent in the fatal cases (P=0.05). Patien...
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Neuroradiologic intervention in two patients with Cerebral Sinus Thrombosis
Nederlands tijdschrift voor geneeskunde, 2000Co-Authors: Charles B. L. M. Majoie, Jan Stam, Menno Sluzewski, Jim A. ReekersAbstract:Two patients with Cerebral Sinus Thrombosis were successfully treated with neuroradiological intervention procedures, one with local thrombolysis and the other with mechanical thrombosuction using a hydrolyser catheter. The first patient, a 20-year-old woman, was treated with asparaginase for acute lymphatic leukaemia. She lapsed into coma with extensor posturing due to superior sagittal and right transverse Sinus Thrombosis. She recovered completely after local thrombolysis with 2,940,000 units urokinase, administered over a period of 40 hours. The second patient was a 29-year-old man who presented with clinical deterioration after seizures due to superior sagittal, left transverse and straight Sinus Thrombosis. A CT-scan demonstrated bilateral haemorrhagic Cerebral infarctions. Since the risk of haemorrhage during thrombolysis with urokinase was considered to be high, mechanical thrombosuction with a hydrolyser catheter was performed. This procedure took only 4 hours. The patient recovered completely in two weeks. These cases add further evidence to the effectiveness of thrombolysis and thrombosuction in selected patients with severe Cerebral Sinus Thrombosis.
Jose M Ferro - One of the best experts on this subject based on the ideXlab platform.
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thrombolysis for Cerebral vein and dural Sinus Thrombosis
Cochrane Database of Systematic Reviews, 2004Co-Authors: Alfonso Ciccone, Patricia Canhao, Filipa Falcao, Jose M Ferro, Roberto SterziAbstract:Background Treatment of Cerebral Sinus Thrombosis with thrombolytics has been reported in cases with a deteriorating clinical course despite anticoagulant therapy. The rationale of this treatment is to promote rapid recanalisation of the occluded Sinus. Objectives To review the available evidence on the efficacy and safety of thrombolysis in confirmed Cerebral Sinus Thrombosis. Search strategy We searched the Cochrane Stroke Group trials register (March 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to March 2003), EMBASE (1980 to March 2003), and reference lists of all relevant publications. Selection criteria We aimed to analyse separately unconfounded randomised controlled trials comparing thrombolytic agent with placebo, or thrombolytic agent with antithrombotic therapy, or thrombolytic agent and antithrombotic with antithrombotic alone, in patients with dural Sinus Thrombosis (confirmed by MR venography, intra-arterial venography or CT venography). Data collection and analysis Two groups of reviewers independently applied the inclusion criteria. Main results No randomised controlled trials were found. Reviewer's conclusions There is currently no available evidence from randomised controlled trials regarding the efficacy or safety of thrombolytic therapy in dural Sinus Thrombosis. A randomised controlled trial is justified to test this therapy especially in patients predicted to have a poor prognosis.
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The Cochrane Library - Thrombolysis for Cerebral vein and dural Sinus Thrombosis.
The Cochrane database of systematic reviews, 2004Co-Authors: Alfonso Ciccone, Patricia Canhao, Filipa Falcao, Jose M Ferro, Roberto SterziAbstract:Background Treatment of Cerebral Sinus Thrombosis with thrombolytics has been reported in cases with a deteriorating clinical course despite anticoagulant therapy. The rationale of this treatment is to promote rapid recanalisation of the occluded Sinus. Objectives To review the available evidence on the efficacy and safety of thrombolysis in confirmed Cerebral Sinus Thrombosis. Search strategy We searched the Cochrane Stroke Group trials register (March 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to March 2003), EMBASE (1980 to March 2003), and reference lists of all relevant publications. Selection criteria We aimed to analyse separately unconfounded randomised controlled trials comparing thrombolytic agent with placebo, or thrombolytic agent with antithrombotic therapy, or thrombolytic agent and antithrombotic with antithrombotic alone, in patients with dural Sinus Thrombosis (confirmed by MR venography, intra-arterial venography or CT venography). Data collection and analysis Two groups of reviewers independently applied the inclusion criteria. Main results No randomised controlled trials were found. Reviewer's conclusions There is currently no available evidence from randomised controlled trials regarding the efficacy or safety of thrombolytic therapy in dural Sinus Thrombosis. A randomised controlled trial is justified to test this therapy especially in patients predicted to have a poor prognosis.
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thrombolytics for Cerebral Sinus Thrombosis a systematic review
Cerebrovascular Diseases, 2003Co-Authors: Patricia Canhao, Filipa Falcao, Jose M FerroAbstract:Background and Purpose: The use of thrombolytics is frequently mentioned in patients with Cerebral venous or dural Sinus Thrombosis (CVDST) who deteriorate despite anticoagulant the
Charles B. L. M. Majoie - One of the best experts on this subject based on the ideXlab platform.
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endovascular thrombectomy and thrombolysis for severe Cerebral Sinus Thrombosis a prospective study
Stroke, 2008Co-Authors: Jan Stam, Charles B. L. M. Majoie, Otto M Van Delden, Krijn P Van Lienden, Jim A. ReekersAbstract:Background and purpose Most patients with Cerebral Sinus Thrombosis (CST) recover after treatment with heparin, but a subgroup has a poor prognosis. Those patients may benefit from endovascular thrombolysis. Methods Prospective case series. Patients with Sinus Thrombosis were selected for thrombolysis if they had an altered mental status, coma, straight Sinus Thrombosis, or large space-occupying lesions. Urokinase was infused into the Sinuses (bolus 120 to 600 x 10(3) U; then 100 x 10(3) U/h) via a jugular catheter, in 15 cases combined with mechanical thrombus disruption or removal. Results We treated 20 patients (16 women), mean age 32 years. Twelve patients were comatose and 14 had hemorrhagic infarcts before thrombolysis. Twelve patients recovered (Rankin score 0 to 2), 2 survived with handicaps, and 6 died. Factors associated with a fatal outcome were leukemia (3/6 versus 0/14, P=0.02) and large hemorrhagic infarcts (4/6 versus 2/14, P=0.04). Seizures were less frequent in the fatal cases (P=0.05). Patients who died had a larger mean lesion surface than survivors (30.5 versus 13.6 cm(2); P=0.03), larger midline shift (5.2 versus 1.7 mm; P=0.02), and a more rapid course (2.7 versus 8.2 days; P=0.01). Five patients who died had large hemispheric infarcts and edema before thrombolysis, causing herniation. Five patients had increased Cerebral hemorrhage (3 minor, 2 major) after thrombolysis. Conclusions Thrombolysis can be effective for severe Sinus Thrombosis, but patients may deteriorate because of increased Cerebral hemorrhage. Patients with large infarcts and impending herniation did not benefit.
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endovascular thrombectomy and thrombolysis for severe Cerebral Sinus Thrombosis a prospective study
Stroke, 2008Co-Authors: Jan Stam, Charles B. L. M. Majoie, Otto M Van Delden, Krijn P Van Lienden, Jim A. ReekersAbstract:Background and Purpose— Most patients with Cerebral Sinus Thrombosis (CST) recover after treatment with heparin, but a subgroup has a poor prognosis. Those patients may benefit from endovascular thrombolysis. Methods— Prospective case series. Patients with Sinus Thrombosis were selected for thrombolysis if they had an altered mental status, coma, straight Sinus Thrombosis, or large space-occupying lesions. Urokinase was infused into the Sinuses (bolus 120 to 600×103 U; then 100×103 U/h) via a jugular catheter, in 15 cases combined with mechanical thrombus disruption or removal. Results— We treated 20 patients (16 women), mean age 32 years. Twelve patients were comatose and 14 had hemorrhagic infarcts before thrombolysis. Twelve patients recovered (Rankin score 0 to 2), 2 survived with handicaps, and 6 died. Factors associated with a fatal outcome were leukemia (3/6 versus 0/14, P=0.02) and large hemorrhagic infarcts (4/6 versus 2/14, P=0.04). Seizures were less frequent in the fatal cases (P=0.05). Patien...
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Neuroradiologic intervention in two patients with Cerebral Sinus Thrombosis
Nederlands tijdschrift voor geneeskunde, 2000Co-Authors: Charles B. L. M. Majoie, Jan Stam, Menno Sluzewski, Jim A. ReekersAbstract:Two patients with Cerebral Sinus Thrombosis were successfully treated with neuroradiological intervention procedures, one with local thrombolysis and the other with mechanical thrombosuction using a hydrolyser catheter. The first patient, a 20-year-old woman, was treated with asparaginase for acute lymphatic leukaemia. She lapsed into coma with extensor posturing due to superior sagittal and right transverse Sinus Thrombosis. She recovered completely after local thrombolysis with 2,940,000 units urokinase, administered over a period of 40 hours. The second patient was a 29-year-old man who presented with clinical deterioration after seizures due to superior sagittal, left transverse and straight Sinus Thrombosis. A CT-scan demonstrated bilateral haemorrhagic Cerebral infarctions. Since the risk of haemorrhage during thrombolysis with urokinase was considered to be high, mechanical thrombosuction with a hydrolyser catheter was performed. This procedure took only 4 hours. The patient recovered completely in two weeks. These cases add further evidence to the effectiveness of thrombolysis and thrombosuction in selected patients with severe Cerebral Sinus Thrombosis.
Patricia Canhao - One of the best experts on this subject based on the ideXlab platform.
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thrombolysis for Cerebral vein and dural Sinus Thrombosis
Cochrane Database of Systematic Reviews, 2004Co-Authors: Alfonso Ciccone, Patricia Canhao, Filipa Falcao, Jose M Ferro, Roberto SterziAbstract:Background Treatment of Cerebral Sinus Thrombosis with thrombolytics has been reported in cases with a deteriorating clinical course despite anticoagulant therapy. The rationale of this treatment is to promote rapid recanalisation of the occluded Sinus. Objectives To review the available evidence on the efficacy and safety of thrombolysis in confirmed Cerebral Sinus Thrombosis. Search strategy We searched the Cochrane Stroke Group trials register (March 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to March 2003), EMBASE (1980 to March 2003), and reference lists of all relevant publications. Selection criteria We aimed to analyse separately unconfounded randomised controlled trials comparing thrombolytic agent with placebo, or thrombolytic agent with antithrombotic therapy, or thrombolytic agent and antithrombotic with antithrombotic alone, in patients with dural Sinus Thrombosis (confirmed by MR venography, intra-arterial venography or CT venography). Data collection and analysis Two groups of reviewers independently applied the inclusion criteria. Main results No randomised controlled trials were found. Reviewer's conclusions There is currently no available evidence from randomised controlled trials regarding the efficacy or safety of thrombolytic therapy in dural Sinus Thrombosis. A randomised controlled trial is justified to test this therapy especially in patients predicted to have a poor prognosis.
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The Cochrane Library - Thrombolysis for Cerebral vein and dural Sinus Thrombosis.
The Cochrane database of systematic reviews, 2004Co-Authors: Alfonso Ciccone, Patricia Canhao, Filipa Falcao, Jose M Ferro, Roberto SterziAbstract:Background Treatment of Cerebral Sinus Thrombosis with thrombolytics has been reported in cases with a deteriorating clinical course despite anticoagulant therapy. The rationale of this treatment is to promote rapid recanalisation of the occluded Sinus. Objectives To review the available evidence on the efficacy and safety of thrombolysis in confirmed Cerebral Sinus Thrombosis. Search strategy We searched the Cochrane Stroke Group trials register (March 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to March 2003), EMBASE (1980 to March 2003), and reference lists of all relevant publications. Selection criteria We aimed to analyse separately unconfounded randomised controlled trials comparing thrombolytic agent with placebo, or thrombolytic agent with antithrombotic therapy, or thrombolytic agent and antithrombotic with antithrombotic alone, in patients with dural Sinus Thrombosis (confirmed by MR venography, intra-arterial venography or CT venography). Data collection and analysis Two groups of reviewers independently applied the inclusion criteria. Main results No randomised controlled trials were found. Reviewer's conclusions There is currently no available evidence from randomised controlled trials regarding the efficacy or safety of thrombolytic therapy in dural Sinus Thrombosis. A randomised controlled trial is justified to test this therapy especially in patients predicted to have a poor prognosis.
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thrombolytics for Cerebral Sinus Thrombosis a systematic review
Cerebrovascular Diseases, 2003Co-Authors: Patricia Canhao, Filipa Falcao, Jose M FerroAbstract:Background and Purpose: The use of thrombolytics is frequently mentioned in patients with Cerebral venous or dural Sinus Thrombosis (CVDST) who deteriorate despite anticoagulant the