Abstract Number ‐ 74: Venous Thrombectomy as Treatment for Central Venous Sinus Thrombosis presenting as symptomatic Idiopathic Intracranial Hypertension

Abstract

Introduction Thrombosis of the cerebral venous sinus (CVST) is an uncommon form of stroke which primarily affects young adults, usually females. Patients with CVST present with either symptoms related to increased intracranial pressure secondary to venous congestion or focal brain injury from infarction or haemorrhage. Treatment of CVST currently involves anticoagulation with venous thrombectomy (VT) used as salvage therapy in refractory CVST. However, the clinical outcomes of patients with symptoms of idiopathic intracranial hypertension (IIH), secondary to CVST, pre‐ and post‐ VT has not been documented. In this case study we present two cases where patients presented with symptoms of IIH secondary to CVST who subsequently underwent VT salvage therapy. Methods We retrospectively analysed institutional data of patients who underwent VT for CVST from 2017–2022. Patients who presented with well documented symptoms of IIH without cerebral infarction or haemorrhage were included. Clinical outcomes including neuroimaging, retinal nerve fibre layer (RNFL) thickness from optical coherence tomography (OCT), visual acuity and use of medications including acetazolamide and anticoagulation were recorded. The technical aspects of the VT procedure are also described. Results Two patients were identified (2 women) that fit the study criteria. Both patients were taking the oral contraceptive pill. They both presented similarly with papilledema and symptoms of IIH including; headache, diplopia and nausea. There was symptomatic progress in both patients despite medical management with anticoagulation and acetazolamide. Patient A, a 39‐year‐old lady, was found to have a severe sagittal sinus thrombosis involving the entire sinus. Her lumbar puncture revealed an opening pressure of 31 cmH2O. She underwent urgent VT which revealed a highly organised thrombus and as such minimal change was achieved with repeated passes, however, her post‐op imaging showed partial recanalization of the right transverse sinus. Patient B, a 26‐year‐old lady, had a partially occlusive right transverse sinus thrombosis extending into the jugular vein. Manometry revealed elevated venous pressures. She underwent VT with alteplase injection to the site of thrombosis. After multiple passes, recanalization of the right transverse sinus was achieved. Post‐operative OCTs demonstrated a significant reduction in RNFLs bilaterally in both patients. Both patients also experienced resolution of symptoms over a few days and remained asymptomatic with gradually decreasing doses of acetazolamide. Conclusions VT may be a safe and effective treatment option in patients with medically refractory CVST who present with symptoms of IIH. In both patients there was marked improvement in symptoms and RNFL thickness after the procedure.