Progressive Superior Sagittal Sinus Thrombosis Successfully Treated With Angioplasty: A Case Report

Although anticoagulation is the standard treatment for cerebral venous sinus thrombosis (CVST), the efficacy of endovascular therapy remains unproven. Medical treatment requires time to show effectiveness, and some patients may have a poor prognosis. Here, we report a case of progressively worsening superior sagittal sinus thrombosis successfully treated with balloon angioplasty, resulting in a favorable outcome. A 68-year-old man presented with right upper limb weakness and aphasia. Head CT revealed a subarachnoid hemorrhage in the left frontal region. Cerebral angiography confirmed the diagnosis of superior sagittal sinus thrombosis. Despite heparin infusion therapy, the patient developed hemorrhagic infarction in the left frontal lobe on day 3 and in the right parietal lobe on day 7. As the patient's level of consciousness deteriorated progressively, balloon angioplasty was performed on day 10 to address stenosis of the superior sagittal sinus. After treatment, the patient showed no further hemorrhage and experienced amelioration in consciousness. Thereafter, anticoagulant treatment was switched to oral warfarin, and the patient was transferred to a rehabilitation facility with residual right hemiparesis and a modified Rankin Scale (mRS) score of three. In conclusion, balloon angioplasty may be a viable therapeutic option for progressive CVST.