A novel combined approach using a Penumbra catheter and balloon catheter for cerebral venous sinus thrombosis

• Published in: BMJ case reports Vol. 2018; p. bcr-2017-013730
• Main Authors: Matsuda, Yoshikazu, Owai, Yoshihiro, Kakishita, Koji, Nakao, Naoyuki
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 26.04.2018; BMJ Publishing Group
• Series: Case Report
• Subjects: Adult; Angioplasty; Anticoagulants - therapeutic use; Blood clots; Carotid arteries; Case reports; Catheterization; Catheters; Cerebral Angiography; Edema; Factor Xa Inhibitors - therapeutic use; Female; Hemorrhage; Heparin - therapeutic use; Humans; Medical imaging; New Devices; Phlebography; Sepsis - complications; Sinus Thrombosis, Intracranial - diagnostic imaging; Sinus Thrombosis, Intracranial - drug therapy; Sinus Thrombosis, Intracranial - etiology; Sinus Thrombosis, Intracranial - surgery; Sinuses; Stents; Stroke; Thrombectomy - instrumentation; Thrombectomy - methods; Thrombosis; Veins & arteries; United States > US; Japan; technique; balloon; catheter; infection; stroke
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2017-013730

Cerebral venous sinus thrombosis is sometimes fatal. We describe a case of sinus thrombosis in a 43-year-old woman presenting with generalized seizure, delirium, and a 2 week history of headache and nausea. The patient underwent mechanical thrombectomy using a novel combined approach, in which a Shouryu HR balloon catheter (Kaneka) was anchored in the right transverse sinus (TS), sigmoid sinus (SS), and superior sagittal sinus (SSS), while a Penumbra 5 MAX ACE (Penumbra) catheter was moved back and forth between the right TS, SS, and SSS. Additionally, back and forth movement of the inflated balloon with aspiration—the so-called ‘dental floss technique’—was performed. Partial recanalization was eventually obtained. Follow-up angiography on postoperative day 7 showed a dramatic improvement in venous outflow. The patient was transferred to a rehabilitation hospital on postoperative day 42. We describe our combined approach using aspiration, and Penumbra and balloon catheters, to achieve mechanical thrombectomy for sinus thrombosis.