PMC9282811_01
(a) Computed tomography (CT) showing a hyperdense signal (arrow) in the straight sinus. (b) CT angiography showing venous flow defect of basal vein and straight sinus. (c) CT performed next day demonstrating venous ischemia at bilateral basal ganglia.
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F1
CVT caused by oral pills was suspected. CT angiography revealed defects in the basal vein of Rosenthal (BVR) and StS [Figure 1b], and the bilateral transverse sinuses (TSs) were not occluded. Moreover, CT demonstrated venous ischemia at bilateral basal ganglia on the following day [Figure 1c], and it was decided that she would undergo MT to improve cerebral venous circulation.
(a) Carotid artery angiogram (CAG) revealing venous flow defect of the basal vein and straight sinus (StS). (b) Late venous phase of CAG demonstrating deep venous congestion. (c) Venography from StS revealing a filling defect of the StS near the confluence (arrow). (d) Mechanical thrombectomy through combined use of an aspiration catheter (arrowhead) and stent retriever (arrow). (e) Postthrombectomy CAG revealing partial recanalization of the StS (arrow).
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F2
Bilateral carotid and vertebral angiograms demonstrated venous flow defects in the BVR and StS [Figure 2a] and deep venous congestion [Figure 2b]. Venography at the StS revealed a filling defect near the confluence [Figure 2c]. Following deployment and anchoring of a Trevo NXT (6 x 37 mm, Stryker) stent retriever through the microcatheter at the StS, the REACT68 catheter was navigated into the StS near the proximal end of the deployed Trevo NXT [Figure 2d]. Although not all thrombi could be removed completely and complete recanalization was not achieved, partial recanalization of the StS was obtained [Figure 2e], and the procedure was terminated at this point.
(a) Computed tomography examination performed at 2 weeks after mechanical thrombectomy, showing improvement of venous ischemia at bilateral basal ganglia. (b) Angiography performed 2 weeks after mechanical thrombectomy, revealing complete recanalization (arrows).
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F3
StS without deep venous congestion [Figure 3b]. She was discharged 3 weeks later, following MT with no neurological deficits with oral anticoagulant therapy.