Mechanical thrombectomy for cerebral venous sinus thrombosis employing a novel combination of Angiojet and Penumbra ACE aspiration catheters: the Triaxial Angiojet technique |
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| Affiliation: | 1. Department of Interventional Neuroradiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA;2. Department of Neurosurgery, Hospital of the University of Pennsylvania, USA;1. Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;2. Oklahoma Comprehensive Brain Tumor Center, University of Oklahoma Health Sciences Center, 1000 N. Lincoln Blvd., Suite 4000, Oklahoma City, OK, USA;1. Department of Neurosurgery, University of Maryland School of Medicine, 22 S Greene Street, Suite 12D, Baltimore, MD 21201, USA;2. Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA;3. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA;4. Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA;5. Department of Anatomy and Neurobiology, University of Maryland School of Medicine, Baltimore, MD, USA;1. Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan;2. Clinical Engineer Section, Clinical Support Department, Hiroshima University Hospital, Hiroshima, Japan;1. University of Illinois Hospital & Health Sciences System, Department of Neurosurgery, Chicago, IL, USA;2. University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, FL, USA;3. Emory University School of Medicine, Emory Faculty Office Building, 49 Jesse Hill Drive SE, #341, Atlanta, GA 30303, USA;4. Department of Neurological Surgery and Neurology, Emory University School of Medicine, Atlanta, GA, USA |
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| Abstract: | Cerebral venous sinus thrombosis (CVST) can be life threatening. A previously healthy woman in her early forties on oral contraceptives presented with global CVST and rapid clinical deterioration. A novel ‘Triaxial Angiojet technique’ (KSAW Shuttle [Cook Inc., Bloomington, IN, USA], 5 MAX ACE [Penumbra Inc., Alameda, CA, USA], and Angiojet [Boston Scientific, Marlborough, MA, USA]) was employed to gain access into the superior sagittal sinus. The 5 MAX ACE reperfusion catheter was shortened prior to placing a 4 Fr Angiojet catheter through it. This resulted in markedly improved recanalization with good anterograde flow. The patient was extubated on postoperative day 2 and discharged neurologically intact on postoperative day 10. We report the first case of placing an Angiojet catheter through a larger Penumbra reperfusion catheter when access through a tortuous sigmoid and transverse sinus could not be obtained with a 6 Fr support catheter. |
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| Keywords: | Mechanical thrombectomy Neurointerventional Novel approach Venous sinus thrombosis |
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