• Koji Omoto, Ichiro Nakagawa, Hun Soo Park, Takeshi Wada, Yasushi Motoyama, Kimihiko Kichikawa, and Hiroyuki Nakase.
• Department of Neurosurgery, Nara Medical University, Nara, Japan.
• World Neurosurg. 2019 Feb 1; 122: 203-208.

BackgroundCerebral venous sinus thrombosis (CVST) is a relatively uncommon cause of stroke in pediatric patients and young adults. The clinical course of CVST is also highly variable. In particular, coma has been noted as a predictor of poor outcome. The standard treatment for CVST in adults is systemic anticoagulation, which can lead to recanalization. Endovascular mechanical thrombectomy (EMT) is considered as possibly indicated in the event of failure to respond to anticoagulation or a comatose state. However, the role of endovascular therapy in the management of pediatric and young adult CVST is unclear. Here, we describe 3 cases of successful emergent EMT for pediatric and young adult CVST presenting in a comatose state.Case DescriptionA 17-year-old boy presented with rapid deterioration and a comatose state despite anticoagulation using heparin. Emergent EMT was performed for CVST. Balloon percutaneous transmural angioplasty and catheter aspiration were repeatedly performed, and partial recanalization of the superior sagittal sinus was achieved by the end of the procedure. The child was discharged without neurologic deficits. Another 2 comatose cases with CVST underwent emergent EMT with balloon percutaneous transmural angioplasty and catheter aspiration, and partial recanalization was again achieved. These patients finally showed complete superior sagittal sinus recanalization and were discharged without neurologic deficits.ConclusionPediatric and young comatose CVST warrants endovascular mechanical thrombectomy as soon as possible.Copyright © 2018 Elsevier Inc. All rights reserved.

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