Technical issues in Cerebral venous sinus thrombosis
Cerebral venous sinus thrombosis mostly affects young adults, and endovascular treatment is not shown to be beneficial. However, EVT is currently contemplated as a rescue technique in several severe cases in which interventionalist rely on off-label use of devices developed mostly for arterial ischemic stroke but also for several different venous pathologies. While there is no exact technique, and literature data is often restricted to case reports and small series, technical aspects complementary to this Slice Issues are further discussed.
Problems faced with current devices and evidence for several techniques(1):
Current data regarding an optimal approach for CVST thrombosis are lacking. Despite numerous published case reports and techniques, due to the unknown benefit of the procedure, a cautious approach would be to use devices that one is familiar with and escalate depending on the result and the severity of the patient. Current silicon models offer the chance to test different techniques and are advised before using novel devices with whom we, as neurointerventionalist, are not familiar directly in patients.
1. Goyal M, Fladt J, Coutinho JM, McDonough R, Ospel J. Endovascular treatment for cerebral venous thrombosis: current status, challenges, and opportunities. J Neurointerv Surg. 2022 Aug 1;14(8):788.
2. Bress A, Hurst R, Pukenas B, Smith M, Kung D. Mechanical thrombectomy for cerebral venous sinus thrombosis employing a novel combination of Angiojet and Penumbra ACE aspiration catheters: the Triaxial Angiojet technique. Journal of Clinical Neuroscience. 2016 Sep 1;31:196–8.
3. Frei D, Huddle D, Bellon R, Dooley G. O-009 Mechanical balloon thromboembolectomy for the treatment of cerebral venous sinus thrombosis (CVT): a restropsective analysis of safety and efficacy in 65 consecutive patients. J Neurointerv Surg. 2011 Jul 1;3(Suppl 1):A4.
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