Chordae Willisii Within the Transverse Sinus: Morphologic Study

Iwanaga, Joe; Courville, Evan; Anand, Mahindra; Khan, Pervez A.; Goren, Oded; Lammle, Markus; Bui, Cuong J.; Dumont, Aaron S.; Tubbs, R. Shane

doi:10.1016/j.wneu.2020.03.024

Cited by 7 publications

(8 citation statements)

References 9 publications

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“…9,10 (2) It has recently been reported that the TS sinus has several luminal septa and pouches. 7,8 These anatomical complexities may disturb the advancement of the GC.…”

Section: Discussionmentioning

confidence: 99%

“…This may be caused by an uneven intraluminal surface, such as one with various septa and pouches in the dural sinus. 7,8 There are several risks associated with introducing a microcatheter or a PTA balloon through the confluence because of several anatomical variations around the confluence. This procedure is contraindicated in cases in which the TS and SSS are not connected.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is difficult for a large-diameter GC to pass through the transverse-sigmoid sinus junction due to its anatomical complexity. 7,8 The effectiveness of an anchoring technique with a percutaneous transluminal angioplasty (PTA) balloon for navigating an 8 F GC into the TS is demonstrated.…”

Section: Introductionmentioning

confidence: 99%

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Balloon anchoring to traverse the sigmoid sinus for delivery of large-caliber venous stents: A technical note

et al. 2021

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Background In the reconstruction of the superior sagittal sinus or transverse sinus, it is desirable to place a large-diameter guiding catheter into the transverse sinus to introduce the stent delivery system smoothly. The utility of an anchoring technique with a percutaneous transluminal angioplasty (PTA) balloon for navigating an 8 F guiding catheter into the transverse sinus is demonstrated. Case Descriptions: Two dural arteriovenous fistula (dAVF) cases (Cognard type II a +b, Borden type II) that underwent sinus stenting are presented. In both cases, when the 8 F guiding catheter was placed in the jugular vein, the stent delivery system could not enter the transverse sinus because it could not pass through the transverse-sigmoid sinus junction. Introduction of an 8 F guiding catheter into the transverse sinus was attempted but failed. An 8-mm or 9-mm PTA balloon was used as a distal anchor, and this technique allowed easier guiding of catheter advancement into the transverse sinus. In both cases, Carotid WALLSTENTS were placed in the sinus easily, with no complications. Conclusion Balloon anchoring in the venous system is useful for achieving large-caliber catheter access across difficult anatomy and is technically feasible.

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“…9,10 (2) It has recently been reported that the TS sinus has several luminal septa and pouches. 7,8 These anatomical complexities may disturb the advancement of the GC.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Balloon anchoring to traverse the sigmoid sinus for delivery of large-caliber venous stents: A technical note

et al. 2021

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“…According to the traditional concept, there were arachnoid granules and fibrous cords in the cerebral venous sinuses (29). These structures were easy to be damaged during MT and lead to new thrombosis in the sinuses (22). When the microcatheter was placed to inject urokinase, one should try to avoid increasing the tension in the bridging vein.…”

Section: Appreciation About Mechanical Thrombectomy In the Superior Smentioning

confidence: 99%

“…The emboli burden was related to the disruption of the thrombus (19,20), which produces clot fragments that flow distally from the dura sinuses into the pulmonary vasculature (21). Moreover, The MT may cause iatrogenic damage to the chordae willisii (CW), which exists in the SSS and, upon damage, would expose its collagen fibers and cause thrombosis (22). In the present study, we created an experimental model with thrombus formation in SSS and mimicked a mechanical thrombectomy (MT) process.…”

Section: Introductionmentioning

confidence: 99%

Impacts on Thrombus and Chordae Willisii During Mechanical Thrombectomy in the Superior Sagittal Sinus

Ding

Liu

et al. 2021

Front. Neurol.

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The anatomical structures of the superior sagittal sinus (SSS) are usually damaged during mechanical thrombectomy (MT), and MT procedure could lead to new thrombosis in the sinuses. However, the mechanism remains unclear. We aimed to investigate the risks of embolism and assess the damage to chordae willisii (CW)-associated MT using a stent passing across the thrombus. A contrast-enhanced in vitro model was used to mimick MT in the SSS. The thrombus was removed with a stent. The emboli generated during the procedure were collected and measured. The residual thrombus area after the MT was measured by J Image software. The damage of CW was evaluated by an endoscope. Three procedural experiments were carried out on each cadaveric sample. The average numbers of visible emboli particles in experiments 1, 2, and 3 were 11.17 ± 2.17, 9.00 ± 2.07, and 5.00 ± 2.96, respectively. The number of large size particles produced by experiment 1 was significantly higher than that of the other experiments. The thrombus area measured after experiment 3 was larger than that of experiments 1 and 2. The number of minor damage cases to CW was 55 (90.16%), and there were six serious damage cases (9.84%). The use of stent resulted in no significant increase in damage to CW after the three experimental procedures. A large amount of thrombi particles was produced during MT, and multiple MT procedures on the same sample can increase residual thrombus area. Moreover, the stent caused minor damages to the CW in SSS.

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Angulation of the dural venous sinuses of the posterior cranial fossa: Anatomical study with clinical and surgical applications

Cardona,

Iwanaga,

Chaiyamoon

et al. 2024

Clinical Anatomy

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Cerebral vein and dural venous sinus thromboses (CVST) account for 0.5%–1% of all strokes. Some structural factors associated with a potentially higher risk for developing CVST have been described. However, angulation of the dural venous sinuses (DVS) has yet to be studied as a structural factor. The current study was performed because this variable could be related to alterations in venous flow, thus predisposing to a greater risk of CVST development. Additionally, such information could help shed light on venous sinus stenosis (VSS) at or near the transverse‐sigmoid junction. The angulations formed in the different segments of the grooves of the transverse (TS), sigmoid (SS), and superior sagittal sinuses (SSS) were measured in 52 skulls (104 sides). The overall angulation of the TS groove was measured using two reference points. Other variables were examined, such as the communication pattern at the sinuses' confluence and the sinus grooves' lengths and widths. The patterns of communication between sides were compared statistically. The most typical communication pattern at the sinuses' confluence was a right‐dominant TS groove (82.98%). The mean angulations of the entire left TS groove at two different points (A and B) were 46° and 43°. Those of the right TS groove were 44° and 45°. The median angulations of the left and right SSS‐transverse sinus junction grooves were 127° and 124°. The mean angulations of the left and right TS‐SSJsv grooves were 111° (range 82°–152°) and 103° (range 79°–130°). Differentiating normal and abnormal angulations of the DVSs of the posterior cranial fossa can help to explain why some patients are more susceptible to pathologies affecting the DVSs, such as CVST and VSS. Future application of these findings to patients with such pathologies is now necessary to extrapolate our results.

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Chordae Willisii Within the Transverse Sinus: Morphologic Study

Cited by 7 publications

References 9 publications

Balloon anchoring to traverse the sigmoid sinus for delivery of large-caliber venous stents: A technical note

Balloon anchoring to traverse the sigmoid sinus for delivery of large-caliber venous stents: A technical note

Impacts on Thrombus and Chordae Willisii During Mechanical Thrombectomy in the Superior Sagittal Sinus

Angulation of the dural venous sinuses of the posterior cranial fossa: Anatomical study with clinical and surgical applications

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