• Gorky Medhi, Subhendu Parida, Patrick Nicholson, Satya Bhusan Senapati, Bimal Prasad Padhy, and Vitor Mendes Pereira.
• Department of Radiology (Interventional Radiology), Sikkim Manipal Institute of Medical Sciences, Central Referral Hospital, Sikkim, India; Division of Neuroradiology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: gorky.medhi@uhn.ca.
• World Neurosurg. 2020 Aug 1; 140: 148-161.

BackgroundCerebral venous sinus thrombosis is a rare cause of acute stroke. It may lead to hemorrhagic venous infarctions, brain swelling, or raised intracranial pressure and can be associated with significant mortality and morbidity. Low-molecular-weight heparin is the mainstay of treatment. Endovascular treatment is reserved for patients who deteriorate despite medical management.MethodsRetrospective evaluation of our institutional databases from 2018-2019 revealed 7 patients who underwent aspiration thrombectomy using large-bore aspiration catheters for recanalization of the dural sinuses with or without intrasinus thrombolysis during the procedure. Their clinical, imaging findings, endovascular technique, and outcome are discussed.ResultsWe treated 7 patients who did not respond to best medical management. Aspiration thrombectomy was the primary mode of endovascular treatment. Adjuvant low-dose (10 mg recombinant tissue plasminogen activator), short-duration (20-minute) intrasinus thrombolysis was used in 4 patients only during the procedure. Headache was the most common symptom, followed by seizures, focal neurologic deficits, and vomiting. There was improvement in clinical condition within 24 hours of procedure in all patients. The 30-day modified Rankin Scale score was 0 in 6 patients. One patient had residual hemiparesis and aphasia. There were no procedure-related complications.ConclusionsThe described technique appears to be simple, safe, and effective and results in a relatively short procedure time in achieving complete or partial recanalization of the dural sinuses in patients who deteriorate despite clinical management. Endovascular thrombectomy along with conventional medical management restores the final drainage pathway of the brain with good clinical outcome.Copyright © 2020 Elsevier Inc. All rights reserved.

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