title: Mechanical thrombectomy for cerebral venous sinus thrombosis employing a novel combination of Angiojet and Penumbra ACE aspiration catheters: the Triaxial Angiojet technique.
abstract: Cerebral venous sinus thrombosis (CVST) can be life threatening. A previously healthy woman in her early forties on oral contraceptives presented with global CVST and rapid clinical deterioration. A novel 'Triaxial Angiojet technique' (KSAW Shuttle [Cook Inc., Bloomington, IN, USA], 5 MAX ACE [Penumbra Inc., Alameda, CA, USA], and Angiojet [Boston Scientific, Marlborough, MA, USA]) was employed to gain access into the superior sagittal sinus. The 5 MAX ACE reperfusion catheter was shortened prior to placing a 4 Fr Angiojet catheter through it. This resulted in markedly improved recanalization with good anterograde flow. The patient was extubated on postoperative day 2 and discharged neurologically intact on postoperative day 10. We report the first case of placing an Angiojet catheter through a larger Penumbra reperfusion catheter when access through a tortuous sigmoid and transverse sinus could not be obtained with a 6 Fr support catheter.
authors.affiliation: Department of Interventional Neuroradiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. Electronic address: aaron.bress@uphs.upenn.edu.
authors.forename: Aaron
authors.initials: A
authors.lastname: Bress
authors.affiliation: Department of Interventional Neuroradiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Hurst
authors.affiliation: Department of Interventional Neuroradiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Pukenas
authors.affiliation: Department of Neurosurgery, Hospital of the University of Pennsylvania, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, Hospital of the University of Pennsylvania, USA.
authors.forename: David
authors.initials: D
authors.lastname: Kung
mesh_terms: D057785:Catheters / Q000009:adverse effects*; D003392:Cranial Sinuses / Q000601:surgery; D005260:Female; D006801:Humans; D012851:Sinus Thrombosis, Intracranial / Q000601:surgery*; D013396:Suction / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*
keywords: Mechanical thrombectomy; Neurointerventional; Novel approach; Venous sinus thrombosis