Mechanical Thrombectomy as a Salvage Procedure for Refractory Cerebral Venous Thrombosis: A Case Series
Darshil Jadhav, Tejesh Shavi, Karishma Hemanathan, M. K. Saranraj, Srinivasan Paramasivam
A
BSTRACT
Background:
Cerebral venous thrombosis (CVT) is a rare cause of stroke that affects young adults and middle-aged patients and is conventionally treated with systemic anti-coagulation therapy. In cases of progressive neurological deterioration or cases refractory to standard anti-coagulation treatment, mechanical thrombectomy can be used to achieve rapid and complete recanalisation of venous sinuses. We reviewed our series to assess the safety, effectiveness of the treatment option and its role in achieving a good functional outcome.
Methods:
A retrospective evaluation of our institution’s database from 2022 to 2024 revealed nine patients who underwent mechanical thrombectomy using large-bore aspiration catheter and stent retrievers for recanalisation of dural venous sinuses with or without intra-sinus thrombolysis during the procedure. Clinical status, image findings, procedure and outcomes are discussed.
Results:
We treated nine patients who did not respond to the best medical management using systemic anti-coagulation. Mechanical venous thrombectomy was done for these patients. Concurrent anti-coagulation was continued. Complete recanalisation of the thrombosed dural sinus with good venous outflow was achieved in all patients. One patient required a decompressive craniectomy as a salvage procedure in view of the mass effect of the haemorrhagic stroke. Modified Rankin scale at 3 months follow-up was <3 for eight patients and the remaining one patient was functionally dependent. There were no procedure-related complications.
Conclusion:
For patients with progressive cerebral venous thrombosis on anti-coagulation therapy, mechanical thrombectomy is a safe and effective treatment option for quick and effective recanalisation with favourable outcomes.