Intrareservoir Administration of Alteplase to Treat a Distal Ventriculoatrial Shunt Obstruction.
Adenocarcinoma
/ complications
Adult
Catheter Obstruction
Cerebrospinal Fluid Shunts
Esophagogastric Junction
Female
Fibrinolytic Agents
/ therapeutic use
Humans
Hydrocephalus
/ etiology
Meningeal Carcinomatosis
/ complications
Postoperative Complications
/ drug therapy
Stomach Neoplasms
/ pathology
Tissue Plasminogen Activator
/ therapeutic use
Alteplase
Tissue plasminogen activator
Ventriculoatrial shunt
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
31
08
2019
accepted:
04
11
2019
pubmed:
13
11
2019
medline:
27
3
2020
entrez:
13
11
2019
Statut:
ppublish
Résumé
Ventriculoatrial shunts can be afflicted with distal malfunctions due to thrombus formation at the distal tip. Distal tip thrombus formation may occur more commonly in oncologic patients who are predisposed to hypercoagulability. A patient who had a ventriculoatrial shunt placed for leptomeningeal carcinomatosis presented with headaches and confusion and was found to have a partial distal shunt obstruction. Intrareservoir administration of alteplase resulted in resolution of her symptoms. Nuclear medicine shunt patency test demonstrated restoration of distal flow. Intrareservoir administration of alteplase can be a useful nonoperative treatment strategy for ventriculoatrial shunt malfunction. This strategy may be particularly useful in cases with higher perioperative risk, such as patients with advanced metastatic cancer.
Sections du résumé
BACKGROUND
BACKGROUND
Ventriculoatrial shunts can be afflicted with distal malfunctions due to thrombus formation at the distal tip. Distal tip thrombus formation may occur more commonly in oncologic patients who are predisposed to hypercoagulability.
CASE DESCRIPTION
METHODS
A patient who had a ventriculoatrial shunt placed for leptomeningeal carcinomatosis presented with headaches and confusion and was found to have a partial distal shunt obstruction. Intrareservoir administration of alteplase resulted in resolution of her symptoms. Nuclear medicine shunt patency test demonstrated restoration of distal flow.
CONCLUSIONS
CONCLUSIONS
Intrareservoir administration of alteplase can be a useful nonoperative treatment strategy for ventriculoatrial shunt malfunction. This strategy may be particularly useful in cases with higher perioperative risk, such as patients with advanced metastatic cancer.
Identifiants
pubmed: 31715416
pii: S1878-8750(19)32849-9
doi: 10.1016/j.wneu.2019.11.013
pii:
doi:
Substances chimiques
Fibrinolytic Agents
0
Tissue Plasminogen Activator
EC 3.4.21.68
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
259-261Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.