血管内局部溶栓治疗颅内静脉窦血栓

Endovascular treatment of cerebral venous sinus thrombosis: local thrombolysis

目的评价局部溶栓与机械碎栓治疗静脉窦血栓的影像学资料与治疗效果.方法对7例静脉窦血栓病人经股静脉穿刺,将微导管选择性插入已闭塞的静脉窦内.6例行静脉窦局部灌注尿激酶或基因重组组织型纤溶酶原激活剂,1例采用球囊机械碎栓术;3例伴脑皮质或深部静脉血栓者同时经颈动脉给予溶栓药.结果造影示6例已闭塞的静脉窦部分再通,1例无明显再通;3例侧支静脉回流增多.1例溶栓后原有脑内血肿增大,导致偏瘫加重;1例术后发生无症状出血性静脉梗死.随访10个月～3年,6例mRankin评分0～1分,1例mRankin评分2分.结论血管内局部溶栓治疗静脉窦血栓,静脉窦完全再通率低,但血管部分再通及侧支静脉回流增多,可改善病人的临床预后.

Objective To assess the neuroimaging data and clinical results of cerebral venous sinus thrombosis treated by endovascular local thrombolysis and mechanical balloon thrombolysis therapy. Methods Among 7 patients of cerebral venous sinus thrombosis, fibrinolytic agents (urokinase or alteplase) were infused into the occlusive lesion of the cerebral venous sinus by the trans-femoral microcatheterization in 6 cases, and mechanical balloon thrombolysis therapy was performed in 1 case. 3 cases with intercurrent cortical or deep venous thrombosis received fibrinolytic via a transcarotid approach simultaneously. Results As shown on arteriogram or venogram of post-fibrinolysis, recanalization achieved partially in 6 cases, inapparently in 1 case, and increased collateral circulation was observed in 3 cases. Neuroimaging data demonstrated that hemorrhagic cerebral lesion enlarged in 1 case and hemorrhagic venous infarction occurred in 1 case, which led to deteriorating situation of hemiplegia after endovascular therapy. Patients were observed for a follow-up time ranged from 10 months to 3 years. As a result, modified Rankin scores 0-1 were achieved in 6 cases, modified Rankin score 2 in 1 case. Conclusion It is difficult to achieve complete recanalization of cerebral venous sinus thrombosis by local endovascular local fibrinolysis, however, partial recanalization and increased collateral venous circulation may improve the clinical outcome of the patients.