Combined use of Solitaire FR and Penumbra devices for endovascular treatment of cerebral venous sinus thrombosis in a child

Abstract

A pre-teenager with newly diagnosed ulcerative colitis presented to an emergency department with acute headache, altered mental status and bilateral lower extremity weakness. Head CT demonstrated acute thrombus in the vein of Galen and straight sinus, and the patient was started on a heparin infusion. The patient clinically deteriorated and became unresponsive. In view of the rapid deterioration despite anticoagulation therapy, the patient was taken for endovascular treatment. A novel endovascular approach was performed with combined use of Solitaire FR and Penumbra devices to enhance access to the straight sinus and to limit intraprocedural blood loss. The post-treatment head CT demonstrated a decrease in hyperattenuation within the vein of Galen and straight sinus. The neurologic status improved within 24 h. The patient was discharged home with a normal neurologic examination.

Keywords: Device; Technique; Thrombectomy; Thrombolysis; Vein.

Figure 1

(A) Axial unenhanced CT showing hyperdense clot within the vein of Galen and straight sinus (arrow). (B) Sagittal reconstruction of two-dimensional time-of-flight MR venography with no visible flow-related enhancement within the expected location of the vein of Galen or straight sinus (arrow). (C) Sagittal T1 MPRAGE post-contrast imaging showing non-enhancing thrombus within the vein of Galen and straight sinus (arrow). (D) Straight sinus venography (lateral view) showing poor filling and intraluminal filling defects compatible with thrombosis. (E) Lateral view after deployment of the Solitaire FR device (arrowheads). (F) Straight sinus venography (lateral view) showing complete filling and rapid washout following thrombectomy.