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Intracranial Dural Sinus Thrombosis: Novel Use of a Mechanical Thrombectomy Catheter and Review of Management Strategies

Shah-Naz Hayat Khan, MD, FRCSC^#,,1, Opeolu Adeoye, MD^*, Todd Anthony Abruzzo, MD, Lori A. Shutter, MD, PT^*, and Andrew Joel Ringer, MD^,,

^# Department of Neurosurgery, Marshfield Clinic Marshfield, Wisconsin
^* Division of Neurosciences Intensive Care,
Department of Neuroradiology, and
Department of Neurosurgery, The Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, Ohio
The Mayfield Clinic, Cincinnati, Ohio

Corresponding Author: Shah-Naz H. Khan, MD, Cerebrovascular and Skull Base Surgery Program, Department of Surgery, Division of Neurosurgery, St. Louis University, School of Medicine, 3635 Vista Avenue at Grand Boulevard, St. Louis, MO 63110-0250, Tel.: 314-577-8715, Fax: 314-268-5061, E-mail: drkhan{at}sasktel.net

Management of intracranial dural sinus thrombosis with involvement of multiple sinuses is complex, often involving not only the primary problem (thrombosis) but acute adverse events consequent to the disease. We highlight the novel use of an endovascular device (typically for suction thrombectomy in the peripheral vascular system) used in our patient with a life-threatening multi-sinus thrombosis. As there is no standard treatment yet for cranial sinus thrombosis, our review of the literature highlights some effective management strategies. A 35-year-old woman developed associated complications of cranial sinus thrombosis that included intracranial hypertension caused by an expanding intracranial hematoma, pulmonary embolism treated by placement of filters in superior and inferior vena cava to eliminate intra- and extracranial sources of emboli, and procedure-related retroperitoneal hematoma that necessitated peripheral vascular intervention. After failure of several common devices during mechanical thrombolysis, a thrombectomy catheter (typically for peripheral vascular intervention to aide in the clot removal) was used. Our case highlights the fine balance of anticoagulation and thrombolysis and the proactive, aggressive approach used by our multispecialty team to manage concurrent factors.

Key Words: Dural sinus thrombosis • endovascular • pulmonary embolism • retroperitoneal hematoma • rt-PA • thrombolysis

¹ Present address: Cerebrovascular and Skull Base Surgery Program, Department of Surgery, Division of Neurosurgery, St. Louis University, School of Medicine, St. Louis, Missouri