Antegrade rheolytic thrombectomy and thrombolysis for superior sagittal sinus thrombosis using burr hole access

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Superior sagittal sinus (SSS) thrombosis has high morbidity and mortality, and urgent recanalization is critical for severe cases. Standard endovascular techniques for thrombolysis and thrombectomy use retrograde venous access, an approach that may be unsuccessful in cases with extensive firm clot burden involving the dural sinuses distal to the SSS. An anterior open transcranial approach to the SSS for catheter sheath placement to facilitate antegrade mechanical thrombectomy and thrombolysis of the SSS and more distal sinuses has not been previously described. Here we describe a case in which multiple unsuccessful attempts at retrograde endovascular access were attempted. Thus, a burr hole over the anterior SSS was performed for daily endovascular antegrade procedures using the Angiojet rheolytic catheter device and chemical thrombolysis. Near-complete recanalization of the SSS was achieved with venous outflow via dilated left transverse and left sigmoid sinuses, along with significant collateral flow in multiple cerebral veins.

Original languageEnglish (US)
Article number011087
JournalBMJ Case Reports
DOIs
StatePublished - Apr 1 2014

Fingerprint

Sagittal Sinus Thrombosis
Superior Sagittal Sinus
Thrombectomy
Endovascular Procedures
Mechanical Thrombolysis
Catheters
Cerebral Veins
Sigmoid Colon
Morbidity
Equipment and Supplies
Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{c581493fb0944576a22381b4ecbf5cb0,
title = "Antegrade rheolytic thrombectomy and thrombolysis for superior sagittal sinus thrombosis using burr hole access",
abstract = "Superior sagittal sinus (SSS) thrombosis has high morbidity and mortality, and urgent recanalization is critical for severe cases. Standard endovascular techniques for thrombolysis and thrombectomy use retrograde venous access, an approach that may be unsuccessful in cases with extensive firm clot burden involving the dural sinuses distal to the SSS. An anterior open transcranial approach to the SSS for catheter sheath placement to facilitate antegrade mechanical thrombectomy and thrombolysis of the SSS and more distal sinuses has not been previously described. Here we describe a case in which multiple unsuccessful attempts at retrograde endovascular access were attempted. Thus, a burr hole over the anterior SSS was performed for daily endovascular antegrade procedures using the Angiojet rheolytic catheter device and chemical thrombolysis. Near-complete recanalization of the SSS was achieved with venous outflow via dilated left transverse and left sigmoid sinuses, along with significant collateral flow in multiple cerebral veins.",
author = "Lee, {Darrin J.} and Latchaw, {Richard E} and Dahlin, {Brian C} and Dong, {Paul R} and Piero Verro and Muizelaar, {Jan Paul} and Kiarash Shahlaie",
year = "2014",
month = "4",
day = "1",
doi = "10.1136/bcr-2013-011087",
language = "English (US)",
journal = "BMJ Case Reports",
issn = "1757-790X",
publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Antegrade rheolytic thrombectomy and thrombolysis for superior sagittal sinus thrombosis using burr hole access

AU - Lee, Darrin J.

AU - Latchaw, Richard E

AU - Dahlin, Brian C

AU - Dong, Paul R

AU - Verro, Piero

AU - Muizelaar, Jan Paul

AU - Shahlaie, Kiarash

PY - 2014/4/1

Y1 - 2014/4/1

N2 - Superior sagittal sinus (SSS) thrombosis has high morbidity and mortality, and urgent recanalization is critical for severe cases. Standard endovascular techniques for thrombolysis and thrombectomy use retrograde venous access, an approach that may be unsuccessful in cases with extensive firm clot burden involving the dural sinuses distal to the SSS. An anterior open transcranial approach to the SSS for catheter sheath placement to facilitate antegrade mechanical thrombectomy and thrombolysis of the SSS and more distal sinuses has not been previously described. Here we describe a case in which multiple unsuccessful attempts at retrograde endovascular access were attempted. Thus, a burr hole over the anterior SSS was performed for daily endovascular antegrade procedures using the Angiojet rheolytic catheter device and chemical thrombolysis. Near-complete recanalization of the SSS was achieved with venous outflow via dilated left transverse and left sigmoid sinuses, along with significant collateral flow in multiple cerebral veins.

AB - Superior sagittal sinus (SSS) thrombosis has high morbidity and mortality, and urgent recanalization is critical for severe cases. Standard endovascular techniques for thrombolysis and thrombectomy use retrograde venous access, an approach that may be unsuccessful in cases with extensive firm clot burden involving the dural sinuses distal to the SSS. An anterior open transcranial approach to the SSS for catheter sheath placement to facilitate antegrade mechanical thrombectomy and thrombolysis of the SSS and more distal sinuses has not been previously described. Here we describe a case in which multiple unsuccessful attempts at retrograde endovascular access were attempted. Thus, a burr hole over the anterior SSS was performed for daily endovascular antegrade procedures using the Angiojet rheolytic catheter device and chemical thrombolysis. Near-complete recanalization of the SSS was achieved with venous outflow via dilated left transverse and left sigmoid sinuses, along with significant collateral flow in multiple cerebral veins.

UR - http://www.scopus.com/inward/record.url?scp=84898667013&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84898667013&partnerID=8YFLogxK

U2 - 10.1136/bcr-2013-011087

DO - 10.1136/bcr-2013-011087

M3 - Article

AN - SCOPUS:84898667013

JO - BMJ Case Reports

JF - BMJ Case Reports

SN - 1757-790X

M1 - 011087

ER -