Role of penumbra mechanical thrombectomy device in acute dural sinus thrombosis

Abstract

Background:In dural venous sinus thrombosis (DVST), the mortality ranges 5–30%. Deep venous system involvement and septic dural sinus thrombosis have a higher mortality rate. In acute occlusion, collateral flow may not be established, which may result in significant edema and mass effect. Endovascular interventions may be considered as a treatment option in appropriate high-risk patients with DVST.Materials and Methods:Eight patients with magnetic resonance imaging (MRI)-confirmed dural sinus thrombosis, who did not respond to the conventional standard medical treatment, were subsequently treated with mechanical thrombectomy using the Penumbra System®. In all cases, medical treatment including anticoagulants were continued following the procedure for a minimum period of 1 year.Results:Recanalization of the dural sinus thrombosis was achieved in all 8 cases. There were no immediate or late endovascular-related complications. One death occurred due to an unrelated medical event. At 6 months, there was notable improvement in the modified Rankin Score (mRS), with 5/8 (62%) patients achieving mRS of 2 or less. The follow-up ranged between 3 months and 26 months (mean: 14.5 months), and there were no new neurological events during the follow-up period.Conclusion:Cerebral venous sinus thrombosis is a rare but life-threatening condition that demands timely diagnosis and therapy. In cases of rapidly declining neurological status despite standard therapy with systemic anticoagulation and anti-edema measures, mechanical thrombectomy could be a lifesaving and effective option. In this study, good outcomes were observed in the majority of patients at long-term follow up.

Endovascular Treatment of Intracranial Vein and Venous Sinus Thrombosis—A Systematic Review

“…Prospective case series, retrospective analyses and case series demonstrated the technical and procedural feasibility and safety of EVT in selected patients ( n = 19; details in Table 1 ) [ 19 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ]. All reported patients were anticoagulated, and those with an expected poor prognosis (such as ICH or edema, neurological deterioration, coma (e.g., GCS < 9), progressive thrombus material observed on repeated imaging or signs of elevated intracranial pressure (e.g., papilledema)).…”

“…In addition, several endovascular techniques have been discussed and investigated: rheolytic catheter thrombectomy, direct aspiration thrombectomy, balloon-guided thrombectomy or angioplasty and stent retriever thrombectomy [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. Information on EVT in SVT is sparse and is based primarily on case series and anecdotal data and only a single published randomized controlled trial (RCT) [ 19 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ]. Therefore, the current guideline recommendations remain vague.…”

Factors influencing therapy choice and clinical outcome in cerebral venous sinus thrombosis

“…MT provides a significantly higher chance of successful recanalization, which is also rapid compared to IST alone, and is associated with a lower risk of bleeding complications when used without IST. Various devices (today, most frequently stent-retrievers) have been used with or without concurrent IST, while each has its specific limitations 8 , 20 , 38 – 40 . The fact that this therapy increases the chance of the achievement of a good outcome has been confirmed by the meta-analysis of 235 patients treated with MT for an unfavorable development of CVST.…”

High-Risk Features of Delayed Clinical Progression in Cerebral Venous Thrombosis: A Proposed Prediction Score for Early Intervention

“…Endovascular therapy is currently used in a subset of patients who clinically or radiographically deteriorate despite anticoagulation, and it is considered an effective salvage option with a reasonable safety profile, but not supported by high-level evidence [4, 6, 7]. It is intuitive to hypothesize that earlier intervention is more likely to be technically efficacious since there is less fibrin cross-linking in the clot.…”