Dual-Stent retriever thrombectomy for extensive dural sinus thrombosis

Abstract

Introduction

First line treatment for cerebral venous thrombosis (CVT) is systemic anticoagulation. In cases with symptoms of elevated ICP, endovascular thrombectomy (EVT) is pursued. We describe two cases in which dual stent-retrievers were used for EVT.

Objectives

The use of dual stent-retrievers has been described in arterial stroke when clot is present in the M1 artery and both M2 branches as a rescue therapy after 1 stent-retriever failed to remove the clot. We applied this same thinking to our EVT patients.

Methods

A 17-year-old female with imaging demonstrating occlusion of the superior sagittal sinus (SSS), dominant right transverse sinus (TS), right sigmoid sinus (SS), and upper right internal jugular vein (IJV). A 20-year-old female with a magnetic resonance venography (MRV) noting CVT in the dominant lateral left TS, SS, and upper left IJV.

Results

Both were taken for EVT due to severity of symptoms. Two 6 × 40 mm stent-retrievers were deployed into the CVT and then remove with continuous aspiration with significant recanalization.

Conclusions

The average diameter of the dural sinuses is 8 mm compared to the average size of the middle cerebral artery 3–4 mm. The largest available SR in the United States is 6 mm, and the largest outer diameter of available aspiration catheters is 2–3 mm. Due to the larger size of the dural sinuses, using two SRs can result in more efficient recanalization and less radiation.

Keywords:

• Endovascular
• thrombectomy
• dural sinus thrombosis

Acknowledgments

This work was supported by a CTSA grant from NCATS awarded to the University of Kansas for Frontiers: University of Kansas Clinical and Translational Science Institute # 5TL1TR002368. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NCATS.

Disclosure statement

The authors whose names are listed certify that they have NO affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethics approva

Requisite consent from patients was obtained for discussion in case report