Cerebral venous thrombosis (CVT) is a rare neurological condition that affects 1.32 to 1.75 per 100,000 annually and accounts for approximately 1% of all strokes 1. Standard first‐line treatment consists of anticoagulation 2. Mechanical thrombectomy may be used in cases in refractory or severe cases but remains controversial due to limited evidence and unclear indications 3. Considerations have included patient age, comorbidities, clot size, symptoms, and time to treat 4,5. Randomized control data suggests no benefit over medical management 5. Current data are primarily based on patients with worsening neurological deficits, hemorrhage, deep CVT, or contraindications to anticoagulation therapy. The current literature lacks examples of patients with CVT treated with mechanical thrombectomy in the absence of risk factors or focal neurological deficits. This self‐case report describes a 25‐year‐old medical student who initially presented with an atypical headache lasting eight days. An MRI of the brain with and without contrast revealed a venous sinus thrombosis along the course of the right transverse sinus, right sigmoid sinus, and right jugular bulb, to the level of the proximal jugular vein. She was treated with enoxaparin for two days but experienced worsening symptoms, including increased headache severity and diplopia. She subsequently underwent a transvenous dural sinus mechanical thrombectomy using a combination of Stentriever, aspiration, and Fogarty balloon techniques over multiple passes. The procedure achieved both angiographic and clinical success, with restoration of venous flow, immediate headache improvement, and return to baseline within one week. The patient was monitored over a five‐day inpatient course and continued anticoagulation therapy as an outpatient. Neurointerventional procedures for CVT are typically reserved for patients with clinical decline, hemorrhage or infarction, stupor or coma, deep CVT, posterior fossa involvement, or contraindications to anticoagulation therapy 2. The decision to pursue thrombectomy in this case was based on early signs of treatment failure and increasing intracranial pressure symptoms, despite the absence of overt neurologic deficit. This case challenges the paradigm of waiting for deterioration and supports individualized consideration of endovascular therapy based on symptom trajectory and clot burden. It also raises questions about whether early mechanical intervention may reduce long‐term cognitive burden, recovery time, and/or surgical risk profile. Further study is required to explore the role of thrombectomy in preservation of cognitive function, including acceleration of recovery timeline. Future studies should also define procedural success metrics to better delineate which patients may benefit from early intervention beyond current severity‐based criteria. image
David Altschul (Sat,) studied this question.