血管内介入治疗颅内静脉窦血栓形成

Endovascular treatment for intracranial venous sinus thrombosis

目的探讨血管内介入方法治疗颅内静脉窦血栓形成的疗效和安全性。方法对27例抗凝治疗无效的颅内静脉窦血栓形成患者行血管内介入治疗,其中19例行局部静脉窦溶栓及机械性破栓治疗,5例行局部静脉窦溶栓、机械性破栓及动脉溶栓治疗,3例行静脉窦支架置入术。结果23例患者的症状、体征明显改善,其中头痛消失18例,视力改善12例;3例症状无改善,出院前22例患者测脑脊液压力正常,血管造影等检查证实21例患者静脉窦主干通畅,皮层静脉和深静脉恢复正常;3例部分再通,皮层静脉和深静脉部分代偿。结论血管内介入治疗是颅内静脉窦血栓形成安全、有效的治疗手段。

Objective To evaluate the efficacy and risk of endovascular treatment for intracranial venous sinus thrombosis. Methods Tewenty seven patients with intracranial venous sinus thrombosis confirmed by CT, MRI, MRV and/or DSA , from 2004 September to 2006 September, were treated with anticoagulant therapy but without response and then followed by multiple modalities including endovascular treatment. Ninteen of them accepted intravenous thrombolysis and mechanical thrombus maceration, another 5 accepted intravenous thrombolysis, mechanical thrombus maceration and intraarterial thrombolysis and the last 3 with stenting. Results After thrombolysis, symptoms and signs of 23 patients improved obviously and headache disappeared in 18 of them, but with only mild degree in other 5 and no improvement in 3. Tewenty one patients among them achieved recanalization of sinuses completely as confirmed on postprocedural angiography, MRI and MRV studies taken prior to hospital discharge and other 3 achieved recanalization of sinuses partly. Conclusion Endovascular treatment is an effective and safe measure for potentially catastrophic intracranial dural sinus thrombosis. （J lntervent Radiol, 2007, 16： 303-306）