Introduction Cerebral venous thrombosis (CVT) accounts for a small percentage of all strokes. While the superior sagittal sinus is the most common location, a subset of CVT involves the deep venous system - the internal cerebral veins, vein of Galen, basal vein of Rosenthal, and thalamostriate veins. Deep CVT can cause thalamic and basal ganglia edema, hemorrhage, and strokes, resulting in disorders of consciousness and subsequent death or dependency. While anticoagulation is the mainstay therapy for CVT, patients with worsening neurologic examinations, strokes, or intracerebral hemorrhage (ICH) may benefit from endovascular therapy and recanalization of the affected vessels. This is complicated in the deep veins by difficult catheterization due to small, fragile vessels. We hypothesize that endovascular treatment of the superficial venous sinuses or the straight sinus alone, without catheterization of deep veins, can result in apparent recanalization of the deep venous sinuses resulting in improved radiologic and clinical outcomes.

Materials/Methods We queried our interventional radiology (IR) database from January 1, 2010 - February 23, 2021 for patients with CVT. This returned a total of 5599 patient encounters containing the search terms, of which 43 had undergone endovascular treatment for CVT. 31 of these patients had venous thrombosis in the superficial sinuses only, while 12 patients had venous thrombosis involving the deep venous system.

Results The 12 patients whose CVT involved deep veins and who underwent endovascular intervention had the following demographics.

All 12 patients underwent intervention due to clinical and/or radiographic worsening despite adequate heparin infusions. 4 patients underwent catheterization of the straight sinus. All other interventions were in the superficial venous sinuses only. All 12 patients with deep venous involvement ultimately had recanalization of the deep system. Modified Rankin scale at discharge was an average of 2.2 (range 0-5).

Conclusions Although deep venous involvement of CVT is uncommon, these patients are at risk of quickly becoming critically ill with an elevated rate of death or dependency. Although these patients may develop stroke, hemorrhage, or neurologic decline prompting consideration of endovascular therapy, the deep cerebral venous system is not easily accessible with catheters due to small lumens and risk of perforation. It has been proposed that deep cerebral veins may have a higher chance of recanalization if venous thrombus burden is reduced in other parts of the dural venous sinuses. Current literature has not fully explored the association between endovascular treatment of the superficial dural venous sinuses and deep venous flow. Our study shows that endovascular recanalization of the superficial venous sinuses and/or straight sinus can subsequently result in recanalization of the deep veins and improve radiologic and clinical outcomes. Prospective trials are still needed to provide further evidence of safety and efficacy.

Disclosures B. Morel: None. J. Hoffman: None. Z. Folzenlogen: None. C. Roark: None. J. Seinfeld: None. D. Case: None.