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Mechanical thrombectomy as first-line treatment for venous sinus thrombosis: technical considerations and preliminary results using the AngioJet device
  1. Shervin R Dashti1,
  2. Yin C Hu2,
  3. Tom Yao1,
  4. David Fiorella3,
  5. Alim P Mitha2,
  6. Felipe C Albuquerque2,
  7. Cameron G McDougall2
  1. 1Norton Neuroscience Center, Norton Healthcare, Louisville, Kentucky, USA
  2. 2Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
  3. 3Department of Neurological Surgery, Stony Brook University Medical Center, Stony Brook, New York, NY, USA
  1. Correspondence to Dr Cameron G McDougall, Neurosurgery, Barrow Neurologic Institute, 2910 N Third Ave, Phoenix, AZ 85013, USA; jaime.canales{at}chw.edu

Abstract

Background Cerebral venous sinus thrombosis (CVT) is an uncommon cause of stroke that is usually treated medically with intravenous heparin therapy followed by long-term anticoagulation therapy. A series of patients with CVT who underwent rheolytic thrombectomy with the AngioJet as a first-line adjunctive treatment in addition to standard anticoagulation therapy is presented.

Methods Prospectively maintained endovascular databases at two institutions were retrospectively reviewed. The available clinical and imaging data were compiled at each institution and combined for analysis.

Results Over 18 months, 13 patients (seven women and six men; age range 17–73 years, median age 45 years) with CVT were treated with rheolytic thrombectomy. Immediate (partial or complete) recanalization of the thrombosed intracranial sinuses was achieved in all patients. At a median radiographic follow-up of 7 months there was continued patency of all recanalized sinuses. Clinical follow-up was available on nine patients: modified Rankin score of 0 in four patients, 1 in three patients and 6 in two patients.

Conclusion This series demonstrates the feasibility of performing mechanical thrombectomy as a first-line treatment for acute CVT. This technique facilitates the prompt restoration of intracranial venous outflow, which may result in rapid neurological and symptomatic improvement.

  • Venous sinus thrombosis
  • rheolytic thrombectomy
  • angiography
  • aneurysm
  • arteriovenous malformation
  • artery
  • spinal cord
  • thrombectomy
  • navigation
  • complication
  • thrombolysis
  • angioplasty
  • vascular malformation
  • orbit
  • pediatrics
  • subarachnoid
  • cervical
  • lesion
  • tumor

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Footnotes

  • Competing interests None.

  • Ethics approval Ethics approval was provided by St Joseph's Hospital and Western IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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