Rapid Thrombectomy of Superior Sagittal Sinus and Transverse Sinus Thrombosis with a Rheolytic Catheter Device

19-year-old woman with nausea, vomiting, headache, and deteriorating mental status.

A, Initial phase-contrast MR venogram with a velocity-encoding value (VENC) of 20 cm/s shows extensive thrombosis of the superior sagittal sinus, the bilateral transverse sinuses, and the straight sinus.

B, Initial lateral superior sagittal sinus venogram reveals extensive thrombus within the superior sagittal sinus and occlusion of the bilateral transverse sinuses. Flow from the occluded superior sagittal sinus is diverted via transmedullary veins to the inferior sagittal sinus (arrows). Arrowhead indicates microcatheter tip.

C, Lateral venogram of the superior sagittal sinus after direct urokinase treatment shows restored anterograde flow but with lengthy tubular filling defects, consistent with residual thrombus (arrows). Arrowhead indicates microcatheter tip.

D and E, Lateral venogram of the straight sinus (D) and anteroposterior image of the left transverse and sigmoid sinuses (E) after direct endovascular urokinase treatment show restoration of anterograde flow but with residual thrombus in all areas (arrows). Arrowheads indicate microcatheter tip.

F, Anteroposterior image of the AngioJet LF140 rheolytic catheter and 0.014-inch guidewire positioned within the superior sagittal sinus via a right sigmoid and transverse sinus approach. Note the tip of the AngioJet catheter device (arrowhead). The relatively straight course of the right sigmoid sinus probably facilitated catheter manipulation and positioning (arrow).

G and H, Postthrombectomy lateral (G) and anteroposterior (H) venograms obtained via a microcatheter (arrowhead) show marked improvement in the appearance of the superior sagittal sinus with minimum residual thrombus (arrows). Rheolytic thrombectomy was subsequently performed in the bilateral transverse sinuses.

I, Posttreatment MR venogram in the coronal projection with a VENC of 20 cm/s documents flow signal throughout much of the superior sagittal and the dominant right transverse sinus.