Document resource
Introduction/Purpose Clinical trials of endovascular treatment (EVT) versus medical therapy of dural venous sinus thrombosis (DVST) have not shown improved outcomes when using thrombolytic infusion, angioplasty, or thrombectomy with stent-retrievers. Nonetheless, EVT may be performed in acute or subacute DVST patients with clinical or imaging deterioration after initial medical therapy. Recent studies have shown increasing large vessel occlusion thrombectomy FPE using super large bore (SLB) 0.088’ inner diameter (ID) catheters, and even larger bore catheters are commonly used in peripheral venous thrombectomy. We describe our initial experience in acute DVST patients using SLB aspiration with HiPoint 88, Tenzing 8 delivery catheter, and BaseCamp sheath (Route 92 Medical, San Mateo, CA).Materials/Methods After IRB approval, we retrospectively reviewed clinical, procedural and imaging data of patients who underwent off-label EVT for DVST with the HiPoint catheter platform from 2021-2025 at 4 centers. Degree of occlusion on venography was scored as: 0 = no filling defect/patent sinus; 1 = filling defects but some flow through sinus; 2 = complete occlusion, no flow. Venous structures were segmented into superior sagittal sinus, torcular, straight sinus, bilateral internal cerebral veins, as well as left and right transverse and sigmoid sinuses jugular bulbs and jugular veins (total of 12 segments, with a maximum thrombus burden score of 24.Results Eighteen patients were identified, 14 female, age 40±14 years. Median pre-procedure GCS was 13 (IQR 7-15). Presenting symptoms included headache (100%), vomiting (67%), weakness (56%), aphasia (44%), seizures (33%) as well as CNVI palsy, papilledema. Hemorrhage was present on initial imaging in 13/18 (72%) and regions of cerebral edema were noted in 16/18 (89%). All received anticoagulation for median of 1 (IQR 0-2) day pre-EVT, with heparin IV infusions used in 17/18. All patients were treated via right CFV 9 F access and Basecamp sheath placement in the IJ below the skull base. HiPoint 88 was successfully delivered over Tenzing 8 to the intended targets for thrombectomy in 17/18 cases (94%). None received IV thrombolytic. Median number of passes per patient was 7 (IQR 4-8). Adjunctive devices were used in 8 patients (BaseCamp for aspiration of the jugular vein in 4, smaller catheters in the straight sinus in 2, combination stent-retriever and HiPoint 88 in 3, initial Sofia 6 F Plus passes prior to HiPoint88 in 1 patient, and Transform 7x7 mm balloon in 1). Venographic improvement of flow was achieved in all but one patient with statistically significant improvement in median thrombus burden score from 12 (IQR 8-14) on intial DSA to 3 (2-7) (p < 0.001) on final DSA. No procedural complications were seen. After IV heparinization, patients were transitioned to long term oral anticoagulation. At discharge, median GCS was 15 (IQR 15-15). At 90 days, median mRS was 0 (IQR 0-1).Conclusion Initial multicenter experience with aspiration thrombectomy of acute DVST using a SLB 0.088’ catheter system resulted in significant venous sinus flow restoration and good clinical outcomes, without complications. Further study in larger patient cohorts is warranted.Disclosures F. Settecase: 1; C; Medtronic, Stryker, Terumo-Microvention. 2; C; Route 92 Medical; Stryker; Rapid.AI. 4; C; Route 92 Medical. M. Alexander: 2; C; Route 92 Medical. 4; C; Route 92 Medical, Piraeus, Certus Critical Care. R. Khangura: None. O. Goren: 1; C; Microvention, Stryker, Rapid Medical. 2; C; Route 92, Microvention, Stryker, Rapid Medical. 3; C; Route 92, Microvention, Stryker, Rapid Medical. D. Tonetti: 2; C; IRRAS. B. Varjavand: None. J. English: 4; C; Route 92 Medical. 5; C; Route 92 Medical. W. Kim: 2; C; Route 92 Medical. 4; C; Route 92 Medical.