Mechanical thrombectomy with the penumbra system for treatment of venous sinus thrombosis.

Abstract

Venous sinus thrombosis can be a fatal condition. When systemic anticoagulation therapy fails or is high risk, endovascular chemical thrombolysis or mechanical thrombectomy may be necessary. We report our experience using the Penumbra system (PS; Penumbra, Alameda, California, USA) in a series of four patients with venous sinus thrombosis. Four patients were treated with mechanical thrombectomy using the PS for venous sinus thrombosis. Three of these patients also underwent balloon angioplasty following the PS device. Utility of this technique was evaluated by procedural success, improvement in neurological condition, avoidance of complications and follow-up imaging. Technical success was achieved in all four patients with restoration of flow in the occluded sinuses without the use of chemical thrombolysis. No complications were encountered during the procedure and no postprocedural complications were attributable to the thrombectomy. One patient with glioblastoma died 6 weeks after the procedure. No new intracerebral hemorrhages were caused and there was no exacerbation of pretreatment intracerebral hemorrhages. Follow-up imaging was available in all but one patient to documented continued sinus patency. Neurologic improvement was seen in all patients after thrombectomy. Two patients have returned for outpatient follow-up and both are doing well. Endovascular treatment for venous sinus thrombosis with the PS is a safe and efficacious alternative to the other forms of mechanical thrombectomy reported in the literature. Good clinical and radiographic results can be obtained without the need for chemical thrombolysis.