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Abstract
Purpose Despite limited evidence of improved outcomes, endovascular treatment is often performed in dural venous sinus thrombosis (DVST) patients with clinical or imaging evidence of deterioration after medical therapy. Clinical trials have not shown improved outcomes using thrombolytic infusion, balloon angioplasty, or mechanical thrombectomy with stent-retrievers. We describe our first-in-human experience using a super-large bore 0.088’ inner diameter (ID) catheter, HiPoint 088, delivered using a tapered shelf-reducing catheter, Tenzing 8, through a 0.10’ BaseCamp guide sheath (Route 92, San Mateo, CA) in DVST patients.
Methods After local IRB approval, we retrospectively reviewed clinical, procedural and imaging data of patients who underwent endovascular therapy for DVST with the BaseCamp, HiPoint 088, and Tenzing 8 our institutions from 2021-2022.
Results Four patients were identified, all female, average age 33±11 years. Each patient had extensive clot burden with complete thrombosis of the superior sagittal sinus (SSS), dominant transverse and sigmoid sinus and jugular bulb, as well as the deep cerebral veins. Two patents had deteriorated to coma immediately pre-procedure. One patient presented with headache progressing to bilateral CNVI palsies, papilledema and vision changes. The fourth patient presented with headache, papilledema and vision changes. All were started on heparin IV infusions. Off-label aspiration thrombectomy was performed using the Tenzing 8, HiPoint 088, Basecamp system. In two cases, the initial 6-7 passes were performed using vacuum aspiration of the Basecamp alone in the high cervical jugular vein/bulb. Subsequent passes were performed by delivering the HiPoint 088 using the Tenzing 8 into the sigmoid sinus and transverse sinus in three cases, and into the SSS in two cases. In one patient, as the HiPoint 088 could not navigate through bilaterally tortuous small caliber jugular-sigmoid sinus anatomy, a HiPoint 070-Tenzing7 were inserted through the HiPoint 088 in telescoping fashion to reach the bilateral sigmoid and transverse sinuses and torcula for 15 AT passes. In all four patients, venous outflow restoration was achieved with no complications. Good clinical outcome were seen at 90 days: 3 patients mRS 0, one with mRS 1. The average number of passes was 11±5. Average procedure time was 203 minutes.
Conclusions The design features of Tenzing 8, HiPoint 088, and BaseCamp, and improve deliverability of a super large bore catheters into the dural venous sinuses, increased aspiration force, and resulted in efficacious venous sinus flow restoration in the setting of DVST with large thrombus burden. Further study in larger patient cohorts is warranted.
Disclosures F. Settecase: 2; C; Stryker, Route 92. W. Kim: 2; C; Stryker, Route 92. 4; C; Route 92. R. Khangura: None. J. English: 2; C; Stryker, Route 92. 4; C; Route 92.