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

Abstract

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.

Anatomical Study of Arachnoid Granulation in Superior Sagittal Sinus Correlated to Growth Patterns of Meningiomas

“…The membranous structure has been recognized as an effective barrier limiting the extension of the tumors ( 16 , 17 ). The internal membranous structures in the SSS, especially for chordae willisii (CW), including the different types (bands, bridges, chords, lamellar, trabecular, and valve-like lamellae), were visualized and described as they behaved physiologically with the aid of an endoscope ( 18 , 19 ). Nevertheless, CWs around AGs, which could affect the sinus extension in meningioma, had not been fully characterized.…”

A Transvenous Endovascular Approach in Straight Sinus Has Minor Impacts on Chordae Willisii

“…This intravascular intervention might result in iatrogenic damages to the chordae willisii (CW) that is present in the superior sagittal sinus (SSS). This damage may lead to subsequent exposure of collagen fibers resulting in thrombus formation (6). However, little literature has been found to support this hypothesis in the SS.…”