Introduction/Purpose The Monopoint Reperfusion System (Route 92 Medical, San Mateo, CA) is a simplified large-bore coaxial aspiration thrombectomy system that tracks over the highly effective Tenzing delivery catheter. Observational studies estimate that the Tenzing catheter has a successful navigation rate of 95.9% in various arterial anatomy, with minimal vasospasm or vascular injury. The randomized controlled trial on the efficacy of the Monopoint Reperfusion System for large vessel occlusions in acute ischemic stroke recently completed enrollment and remains unpublished. Retrospective data on the efficacy and safety of mechanical thrombectomy for refractory cerebral venous thrombosis suggest that complete recanalization of the cerebral sinus is associated with improved clinical outcomes. Whether the Monopoint Reperfusion System is effective in recanalizing medically-refractory, thrombosed cerebral venous sinuses is unknown. We report our early single-center experience using the Monopoint Reperfusion System for mechanical thrombectomy in refractory cerebral venous sinus thrombosis.

Methods and Materials Our institutional endovascular procedural database was leveraged to identify all patients who underwent mechanical thrombectomy for refractory cerebral venous thrombosis using the Monopoint Reperfusion System. Each patient’s baseline demographics, clinical presentation, noninvasive imaging findings, procedural details, and clinical and neuroimaging outcomes were reviewed.

Results Between January 2022 and February 2024, five patients underwent venous thrombectomy with the Monopoint Reperfusion System. All patients presented with medically refractory cerebral venous sinus thrombosis, defined as clinical worsening and thrombus propagation despite therapeutic anticoagulation. All patients were women, with a mean age of 41 years, a pre-morbid modified Rankin scale of 0, a pre-intervention GCS ranging from 8 to 15, and a pre-intervention NIHSS ranging 4 to 19. Suspected etiologies included paroxysmal nocturnal hemoglobinuria, invasive ductal breast carcinoma, puerperal hypercoagulability, and exogenous estrogen use. Pre-interventional imaging was notable for cerebral edema and intraparenchymal hemorrhage in all patients. Thrombosed segments included the superior sagittal sinus in three patients, with occlusions otherwise in the torcula, transverse sinus and straight sinus. Angiographically, all patients demonstrated technically successful recanalization of the initially thrombosed sinuses at procedure completion. All patients remained on therapeutic anticoagulation before and after the procedure. Clinically, three (60%) patients survived to discharge. No complications occurred.

Conclusion Medically refractory cerebral venous sinus thrombosis is a severe disease entity with few available treatment options. The Monopoint Reperfusion System may provide a safe and effective alternative for the affected patients. More studies are warranted to further explore the clinical benefits of this therapeutic option.

Disclosures M. Martucci: None. M. Abdulrazzak: None. R. Achey: None. M. Bain: None. N. Moore: None. J. Tsai: None.