J Korean Neurosurg Soc.  2016 Sep;59(5):518-520. 10.3340/jkns.2016.59.5.518.

Treatment of the Superior Sagittal Sinus Thrombosis with the Mechanical Thrombectomy Using Stent-Retriever Device

• Kim H
• Kim SR
• Park IS
• Kim YW

• KMID: 2351722
• DOI: http://doi.org/10.3340/jkns.2016.59.5.518

Abstract

Cerebral venous sinus thrombosisis an uncommon entity and its clinical presentations are highly variable. We present the case of superior sagittal sinus thrombosis. Although it was medical refractory, successfully treated with mechanical thrombectomy using the Solitaire FR device. A 27-year-old man who presented with venous infarction accompanied by petechial hemorrhage secondary to the superior sagittal sinus (SSS) thrombosis. Due to rapid deterioration despite of anticoagulation therapy, the patient was taken for endovascular treatment. We deployed the Solitaire FR device (4×20 mm) in the anterior portion of the thrombosed SSS, and it was left for ten minutes before the retraction. Thus, we removed a small amount of thrombus. But the sinus remained occluded. We therefore performed the thrombectomy using the same methods using the Solitaire FR (6×20 mm). Thus, we were successful in removing larger clots. Our case highlights not only that the mechanical thrombectomy using the Solitaire FR is effective in achieving revascularization both rapidly and efficiently available, but also that it might be another option in patients with cerebral venous sinus thrombosis who concurrently had rapid clinical deterioration with devastating consequences.

Keyword

Anticoagulation; Cerebral venous thrombosis; Mechanical thrombectomy; Recanalization; Sinus thrombosis; Thrombolysis

MeSH Terms

Adult
Hemorrhage
Humans
Infarction
Sinus Thrombosis, Intracranial
Superior Sagittal Sinus*
Thrombectomy*
Thrombosis*

Figure

• 

  Fig. 1 A and B : Computed and magnetic resonance imaging scans of the right frontal lobe. On brain CT findings, the patient had a hemorrhage in the right frontal lobe and an increased attenuation (white arrow) in the anterior-middle portion of the superior sagittal sinus. C : On follow-up MRI scans, the patient had an increased hemorrhage with the adjacent edema.

• 

  Fig. 2 Lateral digital subtraction angiography of the superior sagittal sinus (SSS). A : On lateral digital subtraction angiography, the patient had a thrombus in the anterior SSS. B : A 6-mm Solitaire FR device was deployed just behind the coronal suture in the SSS for the mechanical thrombectomy (white arrow). C : The thrombus was entangled in the Solitaire FR. D : Follow up magnetic resonance venous image demonstrating complete patency of the previously occluded SSS.

Reference

1. Bagley LJ, Hurst RW, Galetta S, Teener J, Sinson GP. Use of a microsnare to aid direct thrombolytic therapy of dural sinus thrombosis. AJR Am J Roentgenol. 1998; 170:784–786. PMID: 9490974.

2. Borhani Haghighi A, Edgell RC, Cruz-Flores S, Feen E, Piriyawat P, Vora N, et al. Mortality of cerebral venous-sinus thrombosis in a large national sample. Stroke. 2012; 43:262–264. PMID: 21998058.

3. Brockmann C, Kunze S, Scharf J. Computed tomographic angiography of the superior sagittal sinus and bridging veins. Surg Radiol Anat. 2011; 33:129–134. PMID: 20711726.

4. Choulakian A, Alexander MJ. Mechanical thrombectomy with the penumbra system for treatment of venous sinus thrombosis. J Neurointerv Surg. 2010; 2:153–156. PMID: 21990598.

5. Coutinho JM, Stam J. How to treat cerebral venous and sinus thrombosis. J Thromb Haemost. 2010; 8:877–883. PMID: 20149074.

6. Einhäupl K, Stam J, Bousser MG, De Bruijn SF, Ferro JM, Martinelli I, et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients. Eur J Neurol. 2010; 17:1229–1235. PMID: 20402748.

7. Froehler MT. Successful treatment of cerebral venous sinus thrombosis with the Solitaire FR thrombectomy device. BMJ Case Rep. 2012; [Epub ahead print].

8. Girot M, Ferro JM, Canhão P, Stam J, Bousser MG, Barinagarrementeria F, et al. Predictors of outcome in patients with cerebral venous thrombosis and intracerebral hemorrhage. Stroke. 2007; 38:337–342. PMID: 17204682.

9. Hunt MG, Lee AG, Kardon RH, Lesley WS, Chaloupka JC. Improvement in papilledema and visual loss after endovascular stent placement in dural sinus thrombosis. Neuroophthalmology. 2001; 26:85–92. PMID: 12510694.

10. Li G, Zeng X, Hussain M, Meng R, Liu Y, Yuan K, et al. Safety and validity of mechanical thrombectomy and thrombolysis on severe cerebral venous sinus thrombosis. Neurosurgery. 2013; 72:730–738. discussion 730. PMID: 23313983.

11. Raychev R, Tateshima S, Rastogi S, Balgude A, Yafeh B, Saver JL, et al. Successful treatment of extensive cerebral venous sinus thrombosis using a combined approach with Penumbra aspiration system and Solitaire FR retrieval device. J Neurointerv Surg. 2014; 6:e32. PMID: 24049112.

12. Yamashita S, Matsumoto Y, Tamiya T, Kawanishi M, Shindo A, Nakamura T, et al. Mechanical thrombolysis for treatment of acute sinus thrombosis--case report. Neurol Med Chir (Tokyo). 2005; 45:635–639. PMID: 16377952.