多途径联合血管内治疗颅内静脉窦血栓形成

Multiple modality endovascular treatment for intracranial venous thrombosis

目的 研究血管内治疗颅内静脉窦血栓形成的疗效和安全性。方法 自 2 0 0 0年 10月至 2 0 0 1年 10月 ,12例难治性颅内静脉窦血栓形成患者接受了包括经静脉接触性溶栓、机械性破栓、经颈动脉溶栓和静脉窦内支架置入多途径联合血管内治疗。所有病人均有颅内静脉窦血栓形成的危险因素。术后积极治疗原发病 ,抗凝治疗 6个月。术后随访 17～ 2 9个月 ,平均 2 3个月。结果 12例患者均接受了经静脉途径溶栓治疗 ,其中 10例患者同时接受联合机械性血栓切割。 2例患者同时接受经颈动脉途径溶栓治疗。出院时 ,所有患者闭塞静脉窦均再通 ,临床症状改善和颅内压恢复 ,未出现与血管内治疗相关的并发症。Glasgow评分由术前平均 12分 ,恢复到出院时 14分。平均随访 2 3个月 ,无一例血栓再形成。结论 血管内治疗是颅内静脉窦血栓安全、有效的治疗手段。

Objective To review the experience of multiple modality endovascular treatment for intracranial venous thrombosis, and to evaluate the efficacy and risk of endovascular thrombolysis for intracranial venous thrombosis.Methods From October, 2000 to October, 2001, 12 patients with intracranial venous thrombosis confirmed by CT, MRI, MRV, and/or DSA were treated with multiple modality endovascular thrombolysis including intravenous thrombolysis, mechanical thrombus maceration, intraarterial thrombolysis, and stenting.After thrombolysis, treatment aimed at the primary diseases was continued and warfarin was used for 6 months.The patients were followed-up for 17-29 months, averaged 23 months.Results Of the twelve patients, all underwent transvenous thrombolysis, ten underwent combined transvenous thrombolysis and clot maceration, seven underwent transvenous infusion of urokinase combined with transarterial infusion of urokinase.Two underwent transvenous infusion of urokinase combined with transarterial infusion of urokinase.The thrombolysis duration was from one to three days.The infusion dose of urokinase was 800 000 to 2 900 000 IU, the averaging dosage of urokinase was less than 1 000 000 IU per day.All patients achieved from recanalization of sinuses as confirmed on postprocedural angiography, MRI, and MRV studies prior to hospital discharge.At discharge, all the patients improved neurologically, and GCS improved from averaged 12 of pre-operation to 14 of post-operation.During the averaging 23 months follow-up, no patient recurred. Conclusion Combined multiple modality endovascular treatment is an effective and safe procedure for potentially catastrophic intracranial venous thrombosis.