Impacts on Thrombus and Chordae Willisii During Mechanical Thrombectomy in the Superior Sagittal Sinus.

Yuanliang Ye,Jiuyang Ding,Shoutang Liu,Shaoming Huang,Zhu Li,Jianqing Yang,Jiang Huang

doi:10.3389/fneur.2021.639018

Abstract

The anatomical structures of the superior sagittal sinus (SSS) are usually damaged during mechanical thrombectomy (MT), and MT procedure could lead to new thrombosis in the sinuses. However, the mechanism remains unclear. We aimed to investigate the risks of embolism and assess the damage to chordae willisii (CW)-associated MT using a stent passing across the thrombus. A contrast-enhanced in vitro model was used to mimick MT in the SSS. The thrombus was removed with a stent. The emboli generated during the procedure were collected and measured. The residual thrombus area after the MT was measured by J Image software. The damage of CW was evaluated by an endoscope. Three procedural experiments were carried out on each cadaveric sample. The average numbers of visible emboli particles in experiments 1, 2, and 3 were 11.17 ± 2.17, 9.00 ± 2.07, and 5.00 ± 2.96, respectively. The number of large size particles produced by experiment 1 was significantly higher than that of the other experiments. The thrombus area measured after experiment 3 was larger than that of experiments 1 and 2. The number of minor damage cases to CW was 55 (90.16%), and there were six serious damage cases (9.84%). The use of stent resulted in no significant increase in damage to CW after the three experimental procedures. A large amount of thrombi particles was produced during MT, and multiple MT procedures on the same sample can increase residual thrombus area. Moreover, the stent caused minor damages to the CW in SSS.

Highlights

Venous thrombosis can affect all veins in the body including the cerebral venous system leading to cerebral venous thrombosis (CVT) [1]
MT destroys and cuts off the thrombus through physical force, makes the thrombus loose in the venous sinus, recanalizes sinus blood flow. It was especially suitable for patients with refractory CVST such as (I) long duration of thrombosis; (II) ineffective anticoagulant therapy alone or complicated with intracranial hemorrhage; and (III) clinical application of fibrinolytic drugs was impossible, or the dosage of thrombolytic agents has to be reduced after mechanical thrombectomy
Radoslav et al reported that patients with severe cerebral venous sinus thrombosis and cerebral hemorrhage were treated with aspiration and solitaire stent thrombectomy

Summary

Introduction

Venous thrombosis can affect all veins in the body including the cerebral venous system leading to cerebral venous thrombosis (CVT) [1]. Direct intra-sinus infusion of thrombolytic agents may be an effective treatment [10], but this approach may require. Thrombus and Chordae Willisii several days to re-establish anterograde venous outflow in the targeted sinus(es) and may increase the risk of hemorrhagic complications, especially in patients with preexisting hemorrhagic venous infarction. Mechanical thrombectomy (MT) is reasonably safe and effective [12]. It increases the surface area of the thrombus exposed to intra-sinus thrombolysis [13,14,15]

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Conclusion