E-206 Eclipse balloon-assisted straight sinus thrombectomy: a novel technique

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Introduction Cerebral venous sinus thrombosis (CVST) comprises 0.5% of all strokes and usually affects young adults. Its annual incidence is approximated at 4 per 1,000,000 individuals and carries up to an 8.3% mortality rate. Intravenous anticoagulation is considered the first line of treatment. Endovascular approaches may be more efficient in the acute setting and should be considered in cases with involvement of the deep venous system, declining neurological status, or when less invasive treatment options have failed. In this work, we present the case of a 69-year-old male who presented with altered mental status due to straight and left lateral venous sinus thrombosis. We performed a mechanical thrombectomy using an ECLIPSE 2L balloon. Case Report A 69-yeal old male with past medical history of anxiety, depression, and opioid abuse presented to our institution with symptoms of intracranial hypertension, altered mental status, somnolence, and confusion. CSC score was 12. Initial CT showed an acute left temporal lobe infarct with hemorrhagic transformation and CT venogram revealed extensive dural venous sinus thrombosis involving the left transverse and sigmoid sinuses, straight sinus, and vein of Galen. Under general anesthesia, 6-vessel angiography was performed via a transfemoral arterial approach which redemonstrated thrombosis of the straight, transverse and sigmoid. An 8 French long sheath was then inserted into the femoral vein for subsequent venography: An Esperance 0.071’ catheter (Wallaby, Laguna Hills, CA) was advanced over a Headway 27 microcatheter (MicroVention, Aliso Viejo, CA) into the straight sinus. The Headway microcatheter was removed and a 6 × 9 mm ECLIPSE 2L balloon was advanced into the proximal straight sinus over a Hi-Torque Balance Heavyweight 0.014’ microwire (Abbott). The balloon was inflated and withdrawn gently while applying suction to the Esperance aspiration catheter using a Penumbra (Penumbra, Alamada, CA) aspiration pump. This was performed in segments, several times throughout the straight sinus, left transverse, and sigmoid sinuses to generate slow, controlled, suction and aspiration for removal of the large venous clot burden.Post-thrombectomy angiography demonstrated satisfactory recanalization of the straight, left transverse, and sigmoid sinuses. Post-procedurally, the patient presented GCS of 15 without focal neurological deficit. The patient was placed on intravenous heparin drip (aPTT goal of 80–100 sec). On post-operative day one, CT angiography confirmed recanalization of the straight sinus. The patient was discharged home on post-operative day 12 on Eliquis 5 mg twice daily. Hypercoagulability work-up was negative and the CVST was attributed to dehydration and substance abuse. At 3-month follow-up, he remained intact without any neurological deficit with persistently patent venous sinuses on CT angiography. Conclusion Balloon-assisted mechanical thrombectomy is a potentially safe and effective treatment option for patients with extensive CVST or acutely poor neurological status on presentation. The use of a hyper-compliant balloon, such as the Eclipse 2L balloon, may decrease the intraprocedural risk of venous sinus perforation. This is a single institution isolated report of a novel application for the Eclipse 2L balloon and larger prospective studies are warranted. Disclosures K. Papadimitriou: None. S. Mehta: None. D. Golub: None. T. White: None. K. Shah: None. A. Patsalides: None.

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