PMC8718648_01
(A-C) CT head revealing acute multicompartment hemorrhages with left temporal parietal intraparenchymal hemorrhage measuring approximately 3 cm, right frontal subarachnoid hemorrhage and left parietal subarachnoid hemorrhage. No midline shift noted. Hyperdense sign noted (yellow arrow) in the superior sagittal sinus suggesting venous sinus thrombosis. (D,E) MRI brain without contrast FLAIR sequence with right frontal hyperintensity and left parietal hyperintensity consistent with subarachnoid hemorrhage. (F) Left temporal blooming noted (white arrow) on the GRE sequence consisted with intraparenchymal hemorrhage.
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F1
No restricted diffusion noted (Figure 1).
Transvenous endovascular mechanical thrombectomy using the INARI FlowTriever system. (A-C) Right femoral venous access was obtained by placing a 22F GORE DrySeal Flex Introducer Sheath with pre-dilation using 8F, 10F, 14F then 18F dilators. 2 cc of air was inflated in the GORE DrySeal Flex valve to stop back flow of venous blood. (D,E) After selecting the left internal jugular vein; The INARI Triver20 large bore aspiration catheter was advanced with its dilator over the TAD2 exchange wire (Over-the-wire technique) and then the dilator was removed. (F-H) large volume venous clots retrieved using the Vect074 reperfusion catheter and Solitaire stent retriever and negative pressure applied with a 60 cc syringe through the INARI Triver20 large bore aspiration catheter. Anticoagulation with heparin was resumed after the procedure.
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F2
Total fluoroscopy time is 50.8 min, and 70 cc Visipaque 270 low osmolar contrast was used (Figure 2: Procedure technique).