微导丝引导下机械碎栓联合接触溶栓治疗多发性脑静脉窦血栓形成11例

Microwire-guided mechanical disruption and transvenous thrombolysis for multiple cerebral venous sinus thrombosis in 11 cases

目的:多发性脑静脉窦血栓形成临床少见,传统内科抗凝治疗效果很差。采用微导丝引导下机械碎栓联合脑静脉窦内接触溶栓治疗,旨在进一步探讨多发性脑静脉窦血栓形成的有效治疗方法。方法:选择2005-06/2007-04郧阳医学院附属人民医院神经内科收治的多发性脑静脉窦血栓形成患者11例,其中男5例,女6例。进行诊断性数字减影血管造影检查确诊,在微导丝引导下行机械碎栓及接触溶栓治疗,并动态观察症状、体征、颅内压力、影像学改变及有无并发症发生。患者家属对治疗知情同意。结果:11例患者中有10例脑静脉窦实现再通,恢复良好,其中8例完全康复,1例临床症状明显改善,1例仅遗留右下肢轻偏瘫;1例放弃治疗后死亡,有效率高达91%(10/11),无一例并发症发生,随访3个月～2年无复发。结论:微导丝引导下机械碎栓联合接触溶栓治疗多发性脑静脉窦血栓形成可显著提高再通率,减少并发症,改善预后。

AIM：Multiple cerebral venous sinus thrombosis is rare in clinic. Traditional anticoagulant therapy has bad effects. This study investigated the effective ways of treatment for multiple cerebral venous sinus thrombosis by microwire-guided mechanical disruption and transvenous thrombolysis. METHODS：Eleven patients with multiple cerebral venous sinus thrombosis, who were enrolled in Department of Neurology , People’s Hospital, Yunyang Medical College, were selected from June 2005 to April 2007, including 5 males and 6 females. Eleven patients accepted diagnostic Digital Subtraction Angiography, and then eleven patients carried out microwire-guided mechanical disruption and transvenous thrombolysis. At the same time, we closely observed the changes in symptoms, physical sign, intracranial pressure, imaging and complications. The patients and their family members signed the informed consent. RESULTS： Of the 11 patients, there were 10 patients with recanalization of cerebral venous sinuses and significant improvement of clinical conditions. There were 8 patients who fully recovered, 1 patient who improved the clinical symptoms obviously, 1 patient who leaved behind right paraparesis, and 1 patient who died after giving up treating. The rate of efficacy was 91%（10/11）, and no complications were observed. In a follow-up of 3 months to 2 years, there was no recurrence. CONCLUSION： Microwire-guided mechanical disruption and transvenous thrombolysis can significantly improve recanalization, reduce complications and improve prognosis of multiple cerebral venous sinus thrombosis.