Mechanical Venous Thrombectomy Using Indigo Aspiration System: A Case Report

Update time : 2021-09-09

We present a case of successful endovascular thrombectomy of cerebral venous sinus thrombosis utilizing Penumbra’s Indigo Aspiration System (Penumbra Inc., Place Alameda, CA), a minimally invasive system with a large-lumen (Indigo System CAT7, 7F) catheter predominantly used for the removal of thromboembolism involving the peripheral arterial and venous systems. A 30-year-old female presented with a seizure and focal neurological deficits and was found to have a left posterior temporal lobe hemorrhagic infarct secondary to an extensive cerebral venous sinus thrombosis extending from the left transverse sinus to the ipsilateral internal jugular bulb. We considered the combination of seizure, motor deficit, and hemorrhagic infarct high-risk features for poor response to standard medical therapy with therapeutic anticoagulation. Therefore, we performed a mechanical venous thrombectomy with the above device in addition to anticoagulation treatment with heparin infusion. This combination therapy resulted in a technically successful radiographic recanalization of the involved sinuses and an excellent functional outcome at follow-up. This case demonstrates that this trackable, atraumatic, large-bore system was safe and efficacious in the cerebral venous system, permitting near-complete thrombus removal.

Keywords: vascualr neurology, stroke, endovascular thrombectomy, penumbra’s indigo aspiration system, cerebral venous sinus thrombosis (cvst)

Conclusions

Venous sinus recanalization is an important outcome measure in trials investigating endovascular therapies for CVST. Most endovascular tools used for aspiration of CVST are designed for arterial, not venous, vasculature. Penumbra’s Indigo Aspiration System, a large-lumen catheter, can be considered a safe and effective alternative for treating CVST. Future efforts should continue to investigate practical tools for endovascular intervention in CVST, such as the Indigo Aspiration System, to improve patient outcomes and sufficiently answer the question about the efficacy and safety of endovascular therapies for CVST.

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