Drag-out technique using a large balloon fixed with an aspiration catheter for retrieving residual thrombus on the wall of the superior sagittal sinus: illustrative case

BACKGROUND: The authors report a patient with sagittal sinus thrombosis that was resistant to reported endovascular treatments but successfully recanalized by dragging out the thrombus using a large balloon fixed with an aspiration catheter. OBSERVATIONS: A 57-year-old man presented with the persistent headache and a simple partial seizure. Diagnostic study with computed tomography and angiography demonstrated the superior sagittal sinus (SSS) thrombosis. Due to the neurological worsening even after systemic heparinization, the patient underwent mechanical thrombectomy. Despite six passes of stent retrievers and a large-bore aspiration catheter, functional recanalization was not achieved. Therefore, the so-called dental floss technique was attempted using a large compliant balloon catheter (Transform 7 × 7 mm). However, the balloon catheter just wobbled along the lesion without recanalization. To restrict the movement of the balloon catheter, the distal shaft of the balloon catheter was fixed with the aspiration catheter, and both the balloon and the aspiration catheter were slowly pulled to drag the thrombus out, resulting in recanalization of cortical veins as well as the SSS. LESSONS: Dragging the thrombus using a large balloon fixed with an aspiration catheter was a useful technique to retrieve sticky thrombus in the patients with the sinus thrombosis.