Mechanical Thrombectomy for Cerebral Venous Sinus Thrombosis (CVST) in Pregnancy: A Case Report and Review of Literature

Abstract

Background: Cerebral venous sinus thrombosis (CVST) accounts for approximately 0.5–1% of all strokes worldwide, with a disproportionately higher incidence during pregnancy and puerperium due to the hypercoagulable state. A coma, focal neurological deficits, convulsions, or an isolated headache are part of the varied clinical presentation. Anticoagulation remains the first-line treatment, but in patients who worsen despite it, endovascular options such as mechanical thrombectomy or thrombolysis may be used with little evidence to support these therapies during pregnancy.Case Presentation: We report the case of a 28-year-old gravid female, (P1+1 G3) at 9 weeks gestation who presented with acute left-sided weakness, headache, and vomiting. A neurological evaluation showed left hemiplegia (0/5 power), an NIHSS of 16/42, and a Glasgow Coma Scale of 13/15. An MRI-MRA/MRV protocol revealed widespread CVST affecting the transverse, sigmoid, and superior sagittal sinuses complicated by right parenchymal hemorrhage. Laboratory and thrombophilia screens were unremarkable. Initial management with neuroprotective measures, levetiracetam, and therapeutic enoxaparin was instituted. On day two, she developed intractable seizures that responded to phenytoin. Given her clinical deterioration and clot burden, a multidisciplinary team opted for urgent mechanical thrombectomy. Thrombolysis was avoided due to concurrent vaginal bleeding. Results: Successful recanalization was achieved with rapid neurological recovery, improved motor function (5/6) and normalization of consciousness (GCS 15/15). At discharge, she was seizure-free with complete resolution of focal deficits and a viable intrauterine pregnancy. Conclusion: This case highlights the value of mechanical thrombectomy as a safe and effective treatment for refractory CVST in pregnancy in spite of anticoagulation. To optimize both maternal and fetal outcomes, early detection, interdisciplinary collaboration and prompt endovascular therapy are essential.