Endovascular treatment for superior sagittal sinus (SSS)
thrombosis is not always successful because of difficult access and long
thrombus lesions. We report the first two cases of patients with acute cerebral venous
sinus thrombosis at the SSS that was not recanalized by anticoagulation, mechanical
thrombectomy, or thrombolysis, but was successfully treated by
stent placement. Case 1 was a 37-year-old woman with bilateral
subdural hematomas. Digital subtraction angiography showed obstruction of the sinus from the SSS to the right transverse sinus. Recanalization was achieved by selective thrombolysis using
urokinase followed by balloon angioplasty, but re-occlusion occurred on the next day of treatment. Repeated endovascular treatment including balloon angioplasty,
thrombus aspiration and thrombolysis using recombinant
tissue plasminogen activator failed to achieve recanalization. We thus placed intracranial
stents in the SSS, which did achieve recanalization. Case 2 was a 69-year-old woman with a small
infarction in the left parietal lobe. Digital subtraction angiography showed sinus obliteration from the SSS to the bilateral transverse sinuses. Recanalization was not achieved by balloon angioplasty,
thrombus aspiration and selective thrombolysis. We thus placed intracranial
stents in the SSS, which did achieve recanalization. Postoperative course was uneventful in both cases and venous sinus patency was confirmed by venography >1.5 years
after treatment. When conventional endovascular strategies have been unsuccessful, placement of intracranial
stents, which can easily gain access to the distal part of the SSS as compared with carotid
stents, may be a useful treatment option for the acute
sinus thrombosis in this region.