Endovascular mechanical thrombectomy for the treatment of extensive postpartum cerebral venous sinus thrombosis: a case report.

BACKGROUND

Cerebral venous sinus thrombosis (CVST) is a rare but potentially life-threatening complication of pregnancy and the postpartum period. Although systemic anticoagulation remains the standard first-line treatment, evidence supporting endovascular mechanical thrombectomy in postpartum patients is limited.

CASE PRESENTATION: A 22-year-old woman presented 12 days after an uncomplicated vaginal delivery with progressive headache and vomiting. Neuroimaging confirmed extensive CVST involving the superior sagittal, cortical, left transverse, and sigmoid sinuses, extending to the left jugular bulb. An initially suspected bilateral parieto-occipital convexity subarachnoid hemorrhage was subsequently ruled out following further imaging review. Despite prompt anticoagulation with low-molecular-weight heparin, she developed rapid neurological deterioration with decreased level of consciousness. Following multidisciplinary evaluation, endovascular mechanical thrombectomy was performed using aspiration and stent-retriever techniques, achieving successful venous recanalization. The procedure was complicated by transient vasospasm, which resolved after intra-arterial milrinone administration. An extensive evaluation excluded inherited and acquired thrombophilia, autoimmune disease, malignancy, and infection, identifying the postpartum period as the most likely predisposing factor. The patient was discharged 12 days after the intervention with therapeutic anticoagulation and anti-seizure medication. At six-month follow-up, she demonstrated complete neurological recovery without residual deficits.

CONCLUSION

This case highlights that endovascular mechanical thrombectomy may represent a valuable therapeutic option in carefully selected postpartum patients with extensive CVST who develop progressive neurological deterioration despite anticoagulation. Although current evidence remains limited, this report supports the role of a multidisciplinary approach and timely endovascular intervention in achieving favorable neurological outcomes.