多途径介入治疗进展性颅内静窦血栓初步分析

摘要

Objective To determine the effectiveness and safety of the progressively acute cerebral venous sinus thrombosis treated with multiple approaches of endovascular treatments. Methods Retrospective analysis of 24 patients with acute cerebral venous sinus thrombosis who were admitted to Department of Neurology of Beijing Tiantan Hospital, Capital Medical University during Jan. 2012 and Aug. 2015 and were in progressive course after having accepted medical treatments such as anticoagulation and dehydration, were made. Three approaches of endovascular treatments were applied to these patients. The three approaches were catheter-based local chemical thrombolysis, balloon angioplasty and micro wire mechanical thrombectomy and stent mechanical thrombectomy. The demographics data, clinical characteristics, complications and prognosis between the three groups were compared. Results A total of 24 patients received endovascular treatments, among whom, 12 patients accepted catheter-based local chemical thrombolysis, 8 patients accepted balloon angioplasty and micro wire mechanical thrombectomy and 4 patients accepted stent mechanical thrombectomy. Cerebral venous sinus were found entirely recanalized in 11 patients (45.8%); partial recanalization were found in 10 patients (41.7%) and 3 (12.5%) patients were found still occluded. Fourteen patients (58.3%) recovered with no neurological disorders, 8 patients (33.3%) recovered with mild neurological disorders and 2 patients (8.3%) died. Conclusion Therefore, the evidences for justifying the multiple approaches of endovascular treatments are effective and safe for progressively acute cerebral venous sinus thrombosis patients who are not controlled by medical treatment.%目的：探讨血管内治疗急性进展性颅内静脉窦血栓的疗效和安全性。方法选择2012年1月-2015年8月在首都医科大学附属北京天坛医院脑血管病中心经抗凝、脱水降颅内压等药物治疗后病情仍进行性加重的24例急性静脉窦血栓形成的患者，依据病情实施了微导管置管溶栓术、球囊和微导丝机械碎栓联合微导管溶栓术以及支架拉栓联合微导管溶栓术等3种血管内治疗术式。分析患者手术治疗前后的一般状况、临床特征、围手术并发症等资料。结果24例患者中，单独微导管置入溶栓12例，导丝、球囊机械联合微导管溶栓8例，支架拉栓联合微导管溶栓4例。术后11例（45.8%）患者静脉窦完全再通，10例（41.7%）患者静脉窦部分再通，3例（12.5%）患者静脉窦未见通畅。出院时痊愈（不遗留神经功能障碍）14例（58.3%），遗留轻度神经功能障碍8例（33.3%），死亡2例（8.3%）。结论对于内科治疗不能控制的进展性急性颅内静脉窦血栓形成患者，血管内治疗可能是一种安全、有效的治疗手段。