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

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.

Endovascular Mechanical Thrombectomy with a Large-Bore Aspiration Catheter and Stent Retriever for Cerebral Venous Sinus Thrombosis in Pregnancy: A Case Report

“…In addition, there have been some reports of the combined use of aspiration thrombectomy and intrasinus thrombolysis using a penumbra aspiration catheter. 12,13) Aspiration thrombectomy with a large-bore aspiration catheter using REACT 71 was reported by Sundar et al, 14) and may be a safe and effective treatment method for CVST.…”

New Insights on Diagnosis and Treatment of Cerebral Venous Thrombosis – A Narrative Review

“…Although there are still no randomized clinical trials conducted on large groups of patients, during the recent year there are more and more single case studies in which these two invasive therapies combined have been successful. An example of innovation in the field is the therapeutic approach of (Sundar et al, 2020), who successfully performs a thrombectomy in a CVT patient whose general condition worsens after hospitalization, by using a React 71 (large size) device [23]. Similar endovascular approaches with favorable short-and long-term outcomes are found in the recent literature, also in much younger patients (a 5-year-old child and a 10-day-old infant) [24], [25].…”

Drag-out technique using a large balloon fixed with an aspiration catheter for retrieving residual thrombus on the wall of the superior sagittal sinus: illustrative case

“…In the present case, the patient underwent mechanical thrombectomy because direct catheter thrombolysis seemed to have little benefit to recanalize the SSS occluded with large thrombus burden with a higher risk of hemorrhagic complications, as described previously. 10–12 Various methods of mechanical thrombectomy have been reported, such as a stent retriever 3 or a large-bore aspiration catheter, 4 or a combination of the two devices. 5 Balloon angioplasty with or without stenting has also been attempted.…”

“…1 , 2 However, since anticoagulation basically prevents progressive thrombus formation where the drug can reach, venous sinus occlusion with large thrombus is less likely to be recanalized. Endovascular treatments, such as mechanical thrombectomy, 3 aspiration thrombectomy, 4 and combined procedures with a balloon and aspiration catheter 5 , 6 are alternatives in cases refractory to anticoagulation treatment. However, in contrast to arterial embolic stroke, the inflammation-driven thrombus on the wall of the venous sinus is often resistant to such endovascular treatments.…”