Ota Riichi A, Neves Gabriel, Montalvan Victor C, Windisch Thomas, Bushnaq Saif
Neurology, Texas Tech University Health Sciences Center, Lubbock, USA.
Radiology, Covenant Health, Lubbock, USA.
Cureus. 2023 Apr 28;15(4):e38241. doi: 10.7759/cureus.38241. eCollection 2023 Apr.
We present a case of successful endovascular thrombectomy of cerebral venous sinus thrombosis utilizing Penumbra's Indigo Aspiration System (Penumbra Inc., Place Alameda, CA), a minimally invasive system with a large-lumen (Indigo System CAT7, 7F) catheter predominantly used for the removal of thromboembolism involving the peripheral arterial and venous systems. A 30-year-old female presented with a seizure and focal neurological deficits and was found to have a left posterior temporal lobe hemorrhagic infarct secondary to an extensive cerebral venous sinus thrombosis extending from the left transverse sinus to the ipsilateral internal jugular bulb. We considered the combination of seizure, motor deficit, and hemorrhagic infarct high-risk features for poor response to standard medical therapy with therapeutic anticoagulation. Therefore, we performed a mechanical venous thrombectomy with the above device in addition to anticoagulation treatment with heparin infusion. This combination therapy resulted in a technically successful radiographic recanalization of the involved sinuses and an excellent functional outcome at follow-up. This case demonstrates that this trackable, atraumatic, large-bore system was safe and efficacious in the cerebral venous system, permitting near-complete thrombus removal.
我们报告一例使用Penumbra公司的Indigo抽吸系统（位于加利福尼亚州阿拉米达广场的Penumbra公司）成功进行脑静脉窦血栓形成血管内血栓切除术的病例，该系统是一种微创系统，配备大腔（Indigo系统CAT7，7F）导管，主要用于清除累及外周动脉和静脉系统的血栓栓塞。一名30岁女性因癫痫发作及局灶性神经功能缺损就诊，经检查发现其左后颞叶出血性梗死，继发于从左横窦延伸至同侧颈内静脉球部的广泛脑静脉窦血栓形成。我们认为癫痫发作、运动功能缺损和出血性梗死这些综合特征属于高风险特征，提示对标准抗凝药物治疗反应不佳。因此，除了静脉输注肝素进行抗凝治疗外，我们还使用上述设备进行了机械性静脉血栓切除术。这种联合治疗在技术上使受累静脉窦成功实现影像学再通，且随访时功能预后良好。该病例表明，这种可追踪、无创、大口径的系统在脑静脉系统中安全有效，能够近乎完全清除血栓。
