Neurointervention.  2021 Mar;16(1):83-87. 10.5469/neuroint.2020.00304.

Successful Endovascular Treatment of Cerebral Venous Thrombosis with a Novel, Larger Aspiration Catheter (REACT): A Case Report

• Sundar K
• Paulraj S
• Choudhury SR
• Hassan H
• Sengupta J
• Pattari SK

• KMID: 2513350
• DOI: http://doi.org/10.5469/neuroint.2020.00304

Abstract

Cerebral venous thrombosis (CVT) is a rare clinical entity, with clinical presentations extending from headache and seizures to coma and death. For adults developing progressive neurological worsening despite adequate medical management, endovascular thrombolysis and/or mechanical thrombectomy may be considered as treatment options. We present one such patient with CVT who developed seizures and slipped into a coma, despite best medical management. A large-bore aspiration catheter was used as a standalone system for the endovascular procedure. The venous sinuses were successfully re-canalized. The patient was discharged a week later with a modified Rankin scale of 2. Studies show that endovascular thrombolysis used alone or in conjunction with thrombectomy for CVT has a higher risk of hemorrhagic complications. If we were to use mechanical thrombectomy devices (that are specifically designed for intracranial clot retrieval) as a stand-alone system, we would probably have better clinical outcomes with a lower risk of hemorrhagic complications.

Keyword

Cerebral veins; Thrombectomy; Stroke; Brain venous infarction

Figure

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  Fig. 1. (A) Magnetic resonance imaging brain T2 FLAIR images showing hemorrhagic venous infarct in the right cerebral hemispheres. (B) Magnetic resonance imaging venogram shows non visualization (white arrows) of major sinus conduits. (C) Aspiration catheter (black arrows) in the venous system. (D) Photomicrograph of blood clot showed predominantly red blood cells (black arrows) and very little fibrin (white arrow).

• 

  Fig. 2. Pre (A, B) and post (C, D) venous mechanical thrombectomy.

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