A 27-year-old woman at eight weeks' gestation developed sudden onset of right hemiparalysis and
seizures and was referred to our hospital. Her National Institutes of Health
Stroke Scale score on admission was 23. On MRI, diffusion-weighted imaging showed a hyperintensity area in the left frontal lobe, and T2* imaging showed hemorrhagic
infarction in the same area. MR venography showed obstruction of the anterior two-thirds of the superior sagittal sinus (SSS).
Anticoagulant therapy with
heparin was started, but since the venous return was expected to be severely impaired, mechanical
thrombectomy by endovascular surgery was selected, hoping to resolve symptoms early. Using a large-bore aspiration
catheter in combination with a
stent retriever, it was possible to safely guide the aspiration
catheter into the anterior half of the SSS. The use of a large-bore aspiration
catheter enabled retrieval of a large amount of
thrombus in a short time, and complete recanalization was achieved. The patient's
hemiplegia and
aphasia improved significantly within a week after the procedure, and she was discharged without sequelae.
Conclusion: Mechanical endovascular
therapy of CVST performed with a combination of a large-bore aspiration
catheter and a
stent retriever should be considered particularly for patients with severe neurological symptoms or
intracranial hemorrhage and for those who do not respond to anticoagulation
therapy.