Dural venous sinus thrombosis (DVST) is a rare but serious condition in pediatric patients that can lead to extensive neurological compromise. Anticoagulation therapy is the first-line treatment for DVST; however, there is limited guidance for patients whose symptoms persist or worsen despite anticoagulation. In these patients, mechanical venous thrombectomy can be performed. The indigo aspiration and AngioJet thrombectomy systems are devices that have been used successfully in adult patients with peripheral vascular disease and venous occlusion. However, there is limited data on their use in neurointerventional patient let alone pediatric neurointerventional patients with DVST refractory to medical therapy. This is the first publication of the use of these systems for pediatric DVST. We report two cases of pediatric patients (aged 4 and 11 years-old) with acute DVST who underwent endovascular treatment with both the indigo aspiration and the AngioJet systems. The patients were treated between 2021 and 2022. The 11-year-old patient initially presented with headache, lethargy, and coma. MRI/V demonstrated thrombosis of the transverse sinus, sigmoid sinus, straight sinus, vein of Galen, and internal cerebral vein. Extensive venous thrombosis resulted in increased intracranial pressure and T2/FLAIR signal and edema of the thalami and brainstem. The 4 year-old patient presented with headache, gait instability, and prominent scalp veins on his forehead. Workup demonstrated extensive dural venous thrombosis of the dominant sinus. Anticoagulation therapy was initiated, but due to worsening symptoms and lack of improvement, endovascular treatment was performed. Two patients were treated with a combination of the Penumbra indigo aspiration and AngioJet system. The Angiojet was used for thrombus lysis and the Indigo aspiration was used to aspirate the large thrombus pieces to recanalize the sinuses. Thrombus removal was successful in both cases, with restoration of venous flow observed on post-procedural imaging. There were no procedural complications or recurrence of thrombosis during follow-up. Neurointerventional treatment with a unique combination of the Penumbra Indigo aspiration and AngioJet systems have not been described before and can be a safe and effective option for pediatric patients with acute DVST who do not respond to anticoagulation therapy.

Disclosures T. Chaudhry: None. A. Shaibani: None.