PMC7395561_01
(a) Mid sagittal computed tomography (CT) section of the head showing hyperdense thrombus in the straight sinus and vein of Galen (arrows). (b) Contrast-enhanced head CT scan showing opacification of the superior sagittal sinus. There is a lack of opacification of the straight sinus, vein of Galen, and deep veins. (c) CT angiogram (CTA). Occlusion of the left transverse and sigmoid sinuses cannot be seen. (d) Oblique CTA shows occlusion of the straight sinus and vein of Galen. (e) Anteroposterior magnetic resonance venogram shows occlusion of the left transverse and sigmoid sinuses. (f) Lateral magnetic resonance angiogram. The straight sinus and vein of Galen cannot be visualized.
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F1
Noninvasive imaging, including a CT stroke study, CT angiography (CTA), CT venography (CTV), MRI, and MR venography, revealed near-complete occlusion from the vein of Galen through the left sigmoid sinus [Figure 1]. Given the heavy thrombus burden that remained, a velocity microcatheter (Penumbra) was placed in the straight sinus for local infusion of UFH into the deep venous system at a rate of 500 u/h [Figure 2 and Video 1].
(a) Anteroposterior angiogram shows left transverse sinus thrombosis (arrow). (b) Lateral angiogram showing thrombus in the left sigmoid sinus (arrow). (c) Anteroposterior angiogram showing left transverse sinus following thrombectomy. (d) Lateral angiogram shows left sigmoid sinus following thrombectomy. (e) Velocity microcatheter in place (arrows).
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F2
He was then taken emergently to the neuroendovascular suite on hospital day 2 where extensive thrombosis was confirmed [Figure 2]. Partial recanalization was achieved, and the patient returned to the neurointensive care unit [Figure 2]. Given the heavy thrombus burden that remained, a velocity microcatheter (Penumbra) was placed in the straight sinus for local infusion of UFH into the deep venous system at a rate of 500 u/h [Figure 2 and Video 1].
(a) Head computed tomography (CT) scan shows a left cerebellar hematoma (arrow). (b) CT scan obtained postoperatively shows acceptable evacuation of clot.
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F3
He underwent suboccipital craniectomy for hematoma evacuation, and postprocedural imaging showed good decompression of the hematoma [Figure 3].
(a) Anteroposterior computed tomography venogram (CTV) shows reconstitution of the left transverse and sigmoid sinus (arrow). (b) Oblique CTV shows reconstitution of the straight sinus (arrow) and vein of Galen (arrowhead).
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F4
Daily CTA and CTV monitoring showed progressive increases in blood flow throughout the previously thrombosed deep venous system [Figure 4].