Case Report: Mechanical thrombectomy of cerebral venous sinuses using the NeVa stent retriever.

Abstract

Cerebral venous sinus thrombosis (CVST) accounts for less than 1% of cerebrovascular events worldwide and is associated with significant morbidity; in severe or anticoagulation-refractory cases, mechanical thrombectomy is considered, yet no consensus exists on optimal device selection. We report the case of a 32-year-old woman with a history of migraine and oral contraceptive use who presented with sudden-onset headache on awakening, disorientation, and right hemiparesis, followed by focal seizures and National Institutes of Health Stroke Scale (NIHSS) progression from 3 to 7. Magnetic resonance venography confirmed extensive CVST involving the superior sagittal sinus and bilateral transverse and sigmoid sinuses. Mechanical thrombectomy was performed on hospital day 1 via a right jugular approach using a combined aspiration and NeVa stent retriever (5.5 × 37 mm) technique with a 6-second integration time; after six passes, near-complete recanalization of the superior sagittal sinus was achieved with restoration of antegrade venous drainage and no intraprocedural complications. The post-procedural course included neurological improvement (Medical Research Council grade 4/5) and secondary intracranial hypertension (opening pressure 33 cmH₂O), which was managed conservatively. The patient was discharged after 12 days of hospitalization, with a modified Rankin Scale score of 0 at the 34-day follow-up visit. To our knowledge, this represents the first report of off-label NeVa stent retriever use for thrombectomy in the cerebral venous system; the device's higher mesh density may theoretically offer advantages for organized venous thrombi in large-caliber sinuses, expanding therapeutic options where consensus on optimal technique remains elusive.