PMC7533100_01
MR imaging (a and c) and MR venogram in the sagittal view (b). An abnormal signal in the right transverse-sigmoid sinus (white arrowhead), associated with inflammatory changes in the right mastoid is noted in a. Absence of flow signal of a sigmoid sinus and a tight narrowing of the contralateral transverse sinus (white arrowhead) are depicted in b. Bilateral enlargement of the optic nerve sheaths (white waved arrowheads) and bulging of the optic discs (black arrowheads) are depicted in c. Appearances are consistent with an otogenic, right transverse-sigmoid sinus thrombotic occlusion with contralateral transverse sinus tight stenosis and indirect signs of an increased intracranial pressure.
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F1
An MR imaging (MRI) - MR venography (MRV) of the head showed a thrombotic occlusion of the right transverse-sigmoid sinus associated with a tight stenosis of the left transverse sinus [Figures 1a and b] and bilateral enlargement of the optic nerve sheath with bulging of the optic discs [Figure 1c].
DSA Internal jugular vein retrograde injection in the LL view (a), DSA unsubtracted mask in the lateral oblique view (b), DSA, right CCA injection, late venous phase in the lateral oblique (c), and AP views (d). Unsatisfactory, partial recanalization of the lateral transverse and sigmoid sinus at the end of the first endovascular procedure is depicted in a. The following day, mechanical thrombectomy with a double stent-retriever technique (b, white arrowheads) resulted in a satisfactory, although partial, reopening of the transverse and sigmoid sinuses (c and d). Note severe stenosis of the left lateral transverse sinus (white arrowheads in c and d).
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F2
Subsequent check angiograms showed an unsatisfactory partial reopening of the occluded sinus [Figure 2a]. The following morning, a single pass with two unsheathed, and side-to-side 6 x 30 mm Solitaire stent- retrievers ("double stent-retrievers" technique), followed by aspiration through the 6F guider, resulted in a satisfactory reopening of the right sigmoid sinus [Figures 2b and c]. Final angiograms demonstrated an improved cerebral venous outflow [Figure 2d].