title: Manual aspiration thrombectomy for cerebral venous sinus thrombosis.
abstract: BACKGROUND
  Hydration and anticoagulation are the standard of care for cerebral venous sinus thrombosis (CVST) but some patients remain refractory to medical management and warrant more aggressive therapy. Here we present the technique of endovascular transvenous manual aspiration thrombectomy (MAT) in six patients.
  
  
  OBJECTIVE
  Present an alternative technique for endovascular transvenous thrombectomy in a series of CVST patients.
  
  
  METHODS
  We reviewed the records of six patients with medically refractory CVST. Transvenous access via the femoral vein was used to advance an aspiration catheter of varying internal diameter (0.044, 0.054, 0.057, 0.070, 0.072) up to and through the thrombus. Tissue plasminogen activator was administered in select cases. Manual aspiration with a 20 ml syringe applied to the catheter hub was applied as the catheter was slowly retracted. Presentation, technique, and outcome were evaluated.
  
  
  RESULTS
  Clinical presentation included vomiting, dehydration, mental status changes, headaches, and acute motor deficits. On imaging, four of the six patients had hemorrhage, edema, and mass effect present before treatment, while two had edema only. All patients demonstrated continued deterioration despite early and aggressive medical anticoagulation therapy, warranting aggressive intervention. Aspiration of the superior sagittal sinus, transverse sinuses, straight sinus, sigmoid sinus, and internal jugular vein were performed in this series. There were no procedural complications. Revascularization was achieved in all instances. A modified Rankin Scale score of 1-3 was attained in 5/6 patients, while one patient died.
  
  
  CONCLUSIONS
  In this series, transvenous MAT was a safe, simple, and effective revascularization technique to treat patients with CVST who remained refractory to medical management.
authors.affiliation: Department of Neurological Surgery, UPMC, Pittsburgh, Pennsylvania, USA.
authors.forename: Brian Thomas
authors.initials: BT
authors.lastname: Jankowitz
authors.forename: Lance Matukas
authors.initials: LM
authors.lastname: Bodily
authors.forename: Mouhammad
authors.initials: M
authors.lastname: Jumaa
authors.forename: Zaidi F
authors.initials: ZF
authors.lastname: Syed
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001929:Brain Edema / Q000150:complications; D002404:Catheterization; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000150:complications; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005268:Femoral Vein / Q000502:physiology; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D012851:Sinus Thrombosis, Intracranial / Q000401:mortality / Q000601:surgery*; D013396:Suction / Q000379:methods*; D017131:Thrombectomy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator