title: Antegrade rheolytic thrombectomy and thrombolysis for superior sagittal sinus thrombosis using burr hole access.
abstract: Superior sagittal sinus (SSS) thrombosis has high morbidity and mortality, and urgent recanalization is critical for severe cases. Standard endovascular techniques for thrombolysis and thrombectomy use retrograde venous access, an approach that may be unsuccessful in cases with extensive firm clot burden involving the dural sinuses distal to the SSS. An anterior open transcranial approach to the SSS for catheter sheath placement to facilitate antegrade mechanical thrombectomy and thrombolysis of the SSS and more distal sinuses has not been previously described. Here we describe a case in which multiple unsuccessful attempts at retrograde endovascular access were attempted. Thus, a burr hole over the anterior SSS was performed for daily endovascular antegrade procedures using the Angiojet rheolytic catheter device and chemical thrombolysis. Near-complete recanalization of the SSS was achieved with venous outflow via dilated left transverse and left sigmoid sinuses, along with significant collateral flow in multiple cerebral veins.
authors.affiliation: Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA.
authors.forename: Darrin J
authors.initials: DJ
authors.lastname: Lee
authors.forename: Richard E
authors.initials: RE
authors.lastname: Latchaw
authors.forename: Brian C
authors.initials: BC
authors.lastname: Dahlin
authors.forename: Paul R
authors.initials: PR
authors.lastname: Dong
authors.forename: Piero
authors.initials: P
authors.lastname: Verro
authors.forename: J Paul
authors.initials: JP
authors.lastname: Muizelaar
authors.forename: Kiarash
authors.initials: K
authors.lastname: Shahlaie
mesh_terms: D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D012886:Skull / Q000601:surgery; D054063:Superior Sagittal Sinus; D017131:Thrombectomy / Q000379:methods*; D015912:Thrombolytic Therapy / Q000295:instrumentation; D013927:Thrombosis / Q000188:drug therapy* / Q000601:surgery*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Intervention; Technique; Thrombectomy; Thrombolysis