Dual-Stent retriever thrombectomy for extensive dural sinus thrombosis

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Surgery

Background:

• Cerebral venous thrombosis (CVT) typically requires systemic anticoagulation.
• Endovascular thrombectomy (EVT) is indicated for severe CVT with elevated intracranial pressure.
• Limited treatment options exist for complex CVT cases involving large dural sinuses.

Observation:

• Two young female patients presented with severe CVT affecting major dural sinuses.
• Imaging confirmed extensive thrombosis in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, and internal jugular veins.
• Standard EVT with a single stent-retriever was not explicitly detailed as attempted prior to the dual-retriever approach.

Findings:

• A novel technique utilizing dual stent-retrievers was employed for EVT in both patients.
• The dual stent-retriever approach achieved significant recanalization of the occluded cerebral venous sinuses.
• This method was adapted from successful applications in arterial stroke interventions.

Implications:

• Dual stent-retrievers may enhance recanalization efficiency in large-diameter dural sinuses compared to single devices.
• This technique could potentially reduce procedure time and radiation exposure in complex EVT for CVT.
• Further research is warranted to validate the safety and efficacy of dual stent-retrievers in a larger CVT patient cohort.