Abstract Number ‐ 93: Endovascular thrombectomy for cerebral venous sinus thrombosis using the Penumbra Indigo Aspiration System

Abstract

Introduction Cerebral venous sinus thrombosis (CVST) is an uncommon cause of stroke that can be difficult to treat. Endovascular thrombectomy techniques have evolved over time, but evidence behind the efficacy and safety of these techniques for CVST is still lacking. The Penumbra Indigo® Aspiration System (Penumbra, Inc., Alameda, California, USA) is designed to remove emboli from the peripheral arteries and veins and can potentially restore blood flow in cases of limb ischemia and venous thrombosis. We report our initial experience in the treatment of CVST using the Penumbra Indigo® Aspiration System. Methods A 35‐year‐old African American male with no major past medical history presented to the hospital with altered mental status. Computed tomography (CT) showed multiple areas of venous infarction. CT vessel imaging revealed extensive dural venous sinus thrombosis involving the superior sagittal sinus (SSS), torcula, left transverse sinus, right paramedian transverse sinus with partial filling defects in the left sigmoid sinus and distal right transverse sinus with a matched defect in the left paramedian anterior frontal lobe corresponding to the area of evolving infarct. Continuous low‐dose heparin infusion was started. Cerebral angiogram revealed evidence of extremely slow perfusion to the brain with no significant drainage through the dural sinuses with complete occlusion of the distal portion of the SSS and bilateral transverse sinuses. Furthermore, angiogram of the right internal jugular (IJ) vein displayed complete occlusion of the bilateral transverse sinuses. Results An Aristotle® 24, 200‐cm Guidewire (Scientia Vascular, Salt Lake City, Utah, USA) was inserted into a 160‐cm‐long Zoom 35™ catheter (Medtronic, Minneapolis, Minnesota, USA), and this system was then advanced within the CAT12 aspiration catheter within a right IJ 12 French Sheath under fluoroscopic guidance across the occlusion to the superior sagittal sinus, Multiple aspiration attempts were then performed. The CAT 12 Aspiration was performed in the SSS and bilateral transverse sinuses. Afterwards, CAT8 and then CAT7 were then advanced into the thrombus more proximally in the SSS and multiple aspiration attempts were performed in the SSS with the aid of the separator device. There was evidence of partial recanalization of the SSS with significant improved flow of bilateral sigmoid sinuses and bilateral transverse sinuses. A decision was made to stop the intervention. There were no complications related to these procedures. Conclusions The Penumbra Indigo® Aspiration System has been used in various arterial and venous systems but this is the first report to demonstrate its technical feasibility in thrombectomy for CVST. Further feasibility studies are necessary to inform its applicability in CVST.