Mechanical Thrombectomy and Thrombolysis for Dural Venous Sinus Thrombosis

Abstract

Dural venous sinus thrombosis is a rare yet major cause of stroke and mortality, especially affecting young women and children. Anticoagulation is the mainstay of therapy; however, nearly 13% of the patients experience poor outcome with anticoagulation alone.1 In addition, nearly one third of the patients with severe presentation have a risk of incomplete recovery with systemic anticoagulation.2 The subgroup of patients who have incomplete recovery or who develop rapid deterioration in spite of anticoagulation can benefit from mechanical thrombectomy with or without intrasinus thrombolysis. Our patient is a 33-year-old lady on oral contraceptive pills who developed extensive dural venous sinus thrombosis after undergoing lumboperitoneal shunt for pseudotumor cerebri (Video 1). In view of clinical deterioration despite systemic heparin therapy, we performed mechanical thrombectomy and intrasinus thrombolysis using an Angiojet device (Boston Scientific Corporation or its affiliates Inc., Marlborough, Massachusetts, USA). The Angiojet system has the unique capability of a Power Plus technique in which thrombolytic agents can simultaneously be used to facilitate clot removal. However, its utility for intracranial use is limited by the stiffness, large (6-French) catheter diameter, and short length (120 cm). After the procedure, the patient achieved rapid clinical improvement and was maintained on systemic oral anticoagulation. In addition to the case presentation, the video article also demonstrates the technical aspects of mechanical venous thrombectomy.