C27 Rheolytic thrombectomy of the symptomatic cerebral venous sinus thrombosis

<h3>Introduction</h3> Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke, mostly affecting younger individuals. Acquired and genetic predisposing risk factors are presumed to be the causes of hypercoagulable state. The current treatment includes LMWH or NOAC, even in cases with intracerebral hemorrhage. However, patients experiencing rapid clinical deterioration may benefit from early intervention. The efficacy of MT remain uncertain, with limited evidence supporting its use. <h3>Case Description</h3> 23J male was admitted to our hospital with severe headaches, seizure, and acutely decreased consciousness. No focal-neurological deficit was identified. Initial CT scans revealed an intracerebral hemorrhage and edema in the right temporal lobe and thrombosis of the ipsilateral transverse and sigmoid sinus as a cause of the bleeding. Treatment strategies were discussed with the patient‘s family. Given the patient‘s acute clinical deterioration, they opted for endovascular treatment. Mechanical thrombectomy of the transverse and sigmoid sinus, and jugular bulb using aspiration in rheolysis technique and combined technique with Stent-retriever were performed. Periprocedural anticoagulation with IV heparin was administered, monitored with aPTT. No periprocedural complications occured. Prothrombin gene mutation was identified in thrombophilia screen. Patient showed early clinical improvement, and was discharged with NOAC and anticonvulsant therapy. In cases of rapid clinical deterioration, mechanical thrombectomy should be considered as an adjunct to medical therapy. <h3>Conclusions</h3> Rheolytic thrombectomy enhances thrombus fragmentation and facilitates effective recanalisation. Combined approach with stent retriever is particularly useful in sinus curves or for debulking denser thrombi. Diagnosis of prothrombin gene mutation emphasizes the importance of thrombophilia screening in young patients with CVST. <h3>Conflict of Interest</h3> No