Can mechanical thrombectomy be effective in deep cerebral venous thrombosis worsening on anticoagulant? Insight from two cases

Abstract

Objective: Cerebral venous thrombosis (CVT) is a rare condition whose clinical presentation can range from simple headaches to severe impairment of alertness. Some clinical forms, such as involvement of the deep venous system, are associated with a poorer clinical prognosis despite well-managed anticoagulation. The role and timing of rescue mechanical thrombectomy for these patients is not well established.

Method: Clinical and imaging follow-up are discussed according to our treatment decision.

Results: We describe two cases with deep venous system thrombosis that were treated unsuccessfully with optimal anticoagulation, with a spectacular clinical and radiological response after mechanical thrombectomy (MT).

Conclusion: These cases demonstrate that, despite the negative results of the TO-ACT trial, MT could be considered as a rescue treatment in some clinical forms of deteriorating CVT despite optimal anticoagulation.

Keywords: Anticoagulation; Cerebral venous thrombosis; Deep venous system thrombosis; Mechanical thrombectomy; Stroke.