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AJNR - American Journal of Neuroradiology

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Rheolytic Catheter Thrombectomy, Balloon Angioplasty, and Direct Recombinant Tissue Plasminogen Activator Thrombolysis of Dural Sinus Thrombosis with Preexisting Hemorrhagic Infarctions

Kenneth R. Curtin^a, Ali Shaibani^a, Scott A. Resnick^b, Eric J. Russell^a and Tanya Simuni^b

^a Department of Neuroradiology, Northwestern University, Feinberg School of Medicine, Chicago, IL
^b Department of Radiology, Northwestern University, Feinberg School of Medicine, Chicago, IL

View larger version (138K): [in a new window]   FIG 1. Lateral projection skull radiograph shows the tip of the guidewire (arrowhead) extending distal to the tip of the AngioJet catheter (arrow). From this location, the AngioJet catheter was withdrawn over the guidewire to the right jugular bulb (open arrow) while engaged in rheolytic thrombectomy.

View larger version (102K): [in a new window]   FIG 2. Anteroposterior projection superior sagittal sinus venogram obtained via the AngioJet catheter port shows considerable improvement with sinus patency. Extensive filling defects from residual thrombus are present in the superior sagittal, right transverse, and right sigmoid sinuses (arrows). In real time, the antegrade flow was subjectively slow. Transosseous collateral veins are also seen (arrowhead).

View larger version (108K): [in a new window]   FIG 3. Anteroposterior projection venogram obtained after rheolytic thrombectomy and while the AngioJet catheter was withdrawn from the left to the right jugular bulb. Multiple filling defects, representing considerable residual thrombus, are seen in both transverse and sigmoid sinuses (arrows). Prominent collateral veins (arrowheads) in the posterior neck are seen aiding venous drainage of the posterior fossa.

View larger version (85K): [in a new window]   FIG 4. Final anteroposterior venogram obtained on day 3 of endovascular therapy, following completion of mechanical intervention and rtPA infusion shows satisfactory antegrade flow and patency of the superior sagittal sinus, right transverse, and sigmoid sinuses. The nondominant left transverse and sigmoid sinuses remain occluded.