Rheolytic Thrombectomy for Dural Venous Sinus Thrombosis

BACKGROUND AND PURPOSE Cerebral venous thrombosis is a rare condition. Its diagnosis and management can be difficult. Treatment options include systemically delivered anticoagulation or thrombolysis. Intrasinus thrombolysis is an increasingly used intervention but it increases the risk of hemorrhage, especially in patients who have a rapidly deteriorating neurological condition. Mechanical thrombectomy that provides rapid canalization without increased risk of hemorrhage is an attractive alternative treatment. METHODS We describe the use of AngioJet rheolytic thrombectomy in 4 patients with extensive cerebral venous sinus thrombosis, preexisting intracranial hemorrhage, and severe progressive neurological deficit despite heparin therapy. RESULTS Partial or complete sinus patency was restored in all 4 patients and complete neurological recovery was achieved in 3 patients. CONCLUSION Intracranial hemorrhage or a rapidly deteriorating neurological condition may preclude the use of thrombolytic agents in the treatment of patients with cerebral venous sinus thrombosis. In such patients, mechanical thrombectomy offers a useful alternative. J Neuroimaging 2009;19:366-369.