Therapeutic intervention of cerebral venous sinus thrombosis with visual impairment using the EKOS Endovascular System: illustrative cases.

BACKGROUND: Cerebral venous sinus thrombosis (CVST) can cause vision loss from intracranial hypertension. Standard anticoagulation may be inadequate in severe cases. The EKOS Endovascular System enables ultrasound-assisted thrombolysis and may provide a targeted therapeutic alternative. OBSERVATIONS: Three patients with CVST and severe visual dysfunction underwent EKOS after conventional therapy failed. Two patients, aged 32 and 42 years, treated within days of symptom onset, demonstrated marked visual recovery and resolution of papilledema following 24-hour thrombolysis. A third patient, aged 20 years, presented late and achieved papilledema resolution but limited visual recovery, emphasizing the importance of early treatment. All procedures were technically successful, well tolerated, and complication free. LESSONS: EKOS thrombolysis may represent a safe, effective option for CVST with vision-threatening intracranial hypertension, particularly after anticoagulation failure. Early intervention appears critical to optimize outcomes. Larger studies are warranted to confirm the safety, efficacy, and optimal treatment window. https://thejns.org/doi/10.3171/CASE25364.