Use of mechanical thrombolysis via microballoon percutaneous transluminal angioplasty for the treatment of acute dural sinus thrombosis: Case presentation and technical report

OBJECTIVE AND IMPORTANCE: Although conventional superselective chemical thr ombolysis is frequently successful for the treatment of severe acute dural sinus thrombosis, the technique has limitations and risks. This prompted us to develop a supplemental technique for achieving more rapid recanalizatio n, using coronary microballoon percutaneous transluminal angioplasty cathet ers. We describe a successful application of this technique and technology that has not been previously reported. CLINICAL PRESENTATION: After several days of severe headaches, photophobia, and vomiting, a 29-year-old woman presented with rapidly progressive neuro logical deficits secondary to complete occlusion of the superior sagittal s inus (SSS) and right transverse/sigmoid sinus complex. Owing to her rapid n eurological decline, she was referred for emergency endovascular interventi on. TECHNIQUE: Initially, superselective chemical thrombolysis of the SSS was p erformed using urokinase. However, because of the extensive nature of the t hrombus and lack of initial therapeutic response, we elected to attempt mec hanical thrombolysis with various coronary percutaneous transluminal angiop lasty microballoon catheters. This was accomplished by initial coaxial posi tioning of the device into an occluded segment, followed by gentle inflatio n and retraction of the device along the course of the right transverse sin us and/or SSS. These maneuvers were repeated with balloons of increasingly large diameter. Near-complete restoration of venous outflow was obtained wi thin the SSS with preferential runoff into the left transverse sinus. The r ight transverse sinus was only partially recanalized. Despite the patient's rapid neurological decline on presentation, she experienced a dramatic cli nical recovery with near-complete reversal of neurological deficits within 24 hours of intervention. CONCLUSION: This report shows the feasibility of performing safe and effect ive mechanical thrombolysis with percutaneous transluminal angioplasty coro nary balloon microcatheters within the major dural sinuses. This technique can probably accelerate clot disruption and thrombolysis, possibly resultin g in a more rapid restoration of venous flow.