Successful treatment of extensive cerebral venous sinus thrombosis using a combined approach with Penumbra aspiration system and Solitaire FR retrieval device

Abstract

We present a young woman with rapidly progressive neurologic decline in the setting of malignant cerebral edema due to extensive superior sagittal sinus thrombosis and cortical venous thrombosis despite intravenous heparin administration. Complete revascularization of the occluded sinus was achieved using suction thrombectomy with the 5 max Penumbra catheter in combination with the Solitaire FR clot retrieval device. The successful endovascular treatment halted the progression of her cerebral edema, and the patient eventually had an excellent recovery after prolonged intensive medical therapy. To our knowledge, this is the first reported case describing such a combined mechanical approach for cerebral venous sinus thrombosis. The clot retrieval properties of the Solitaire device combined with direct aspiration via the newest generation Penumbra catheters may allow more rapid, safe and efficient revascularization than all previously reported endovascular treatments for this potentially devastating condition.

Endovascular treatment of cerebral venous thrombosis: Contemporary multicenter experience

“…Two other cases of successful experience with this technique for the treatment of CVT were also recently described in the literature. 9,14 This particular approach is believed to offer the advantage of simultaneous application of aspiration force of the Penumbra system along with capture of large clots within the struts of the stent retriever.…”

“…7,8 With the introduction of stent retrievers and modifications of aspiration thrombectomy catheters for the treatment of ischemic stroke, several single cases and small case series have demonstrated the promising role of these new devices for the treatment of CVT. [9][10][11][12] The goal of our study was to collect and review data regarding the current endovascular treatment strategies in patients with CVT.…”

Rescue N-butyl-2 cyanoacrylate embolectomy using a Solitaire FR device after venous glue migration during arteriovenous malformation embolization: technical note

“…9,10 To our knowledge, this is the first case reported in the literature of a Solitaire FR device used for rescue following an involuntary acrylic glue migration into the draining vein. A stent-retriever device has already been used to retrieve coils, both in arterial and venous circulation.…”

Two Cases of Cerebral Venous Sinus Thrombosis Successfully Recanalized by the Concomitant Use of an Aspiration through the Guiding Catheter and Stent Thrombectomy Device

“…[4][5][6][7] Methods such as thromboaspiration combined with conventional thrombolytic therapy, mechanical thrombofragmentation, and mechanical thrombectomy have also been reported. [8][9][10][11][12][13][14][15] According to the systematic review of endovascular treatment for CVST performed at 42 institutions (185 cases) between January 1995 and February 2014 by Siddiqui et al, the mainstay of treatment was AngioJet (40%), followed by the snare (31%), balloon angioplasty (25%), and Penumbra system (7%), and endovascular treatment with that of heparin anticoagulant therapy is in progress, and its results are awaited. 3) We selected endovascular treatment in the two patients reported here because they showed progressive headache, nausea, and restlessness and were judged to need prompt control of symptoms.…”