rt-PA静脉窦注射结合血管内技术治疗重症颅内静脉窦血栓

Intrasinus administering rt- PA combined with mechanical thrombectomy for serious cerebral venous sinus thrombosis

目的探讨重组组织血浆纤维蛋白溶酶原激活剂（rt—PA）静脉窦注射结合机械性血栓清除治疗重症颅内静脉窦血栓的效果。方法11例重症颅内静脉窦血栓患者，共进行血管内介入治疗15次；其中机械性血栓清除结合rt—PA静脉窦局部注射14例次，单纯机械性血栓清除1次；应用AngioJet导管清除血栓9次，球囊血栓清除5次，微导丝1次。进行2次血管内治疗者4例，进行1次血管内治疗7例。每次血管内治疗rt—PA用量0～15mg，平均（9．4±4．5）mg。无介入治疗并发症发生。手术均在气管插管全麻下进行，患者介入治疗前、治疗中及治疗后均进行全身肝素化治疗。结果本组11例患者接受血管内治疗时已发生意识障碍8例，其中6例已行气管插管，2例已发生脑疝；GCS3～12分，平均（8．3±2．7）分。恢复优良8例，死亡3例。存活病例MRI／MRV随访10—32个月（平均21个月），静脉窦通畅6例，部分通畅2例。无静脉窦血栓复发病例。结论重症颅内静脉血栓可危及病人的生命，常规治疗疗效差。溶栓药物局部应用结合机械性血栓清除可以快速使受累的静脉窦恢复通畅，是一种安全、有效的治疗方法。

Objective To investigate the effect of endovascular interventional therapy, intrasinus administered recombinant tissue plasminogen activator（ rt -PA） combined with mechanical thrombectomy for serious cerebral venous sinus thrombosis（CVST）. Method Eleven patients with serious CVST were accepted endovascular interventional therapy under general anaesthesia and systemic heparinization. Fifteen procedures were performed： rhcolytic thrombectomy with AngioJet catheter combined with intrasinus rt -PA thrombolysis in eight procedures, AngioJet catheter thrombectomy without intrasinus rt -PA thrombolysis in one procedure, and clot disruption with micro - balloon or micro - guidwire combined with intrasinus rt - PA thrombolysis in six procedures. Four of eleven patients were required a second endovascular interventional treatment for partial rethrombosis after the first procedure. Total rt -PA dose per procedure was ranged from 0 to 15 mg,mean （9. 4 ±4. 5）mg. All of the procedures were technically successful, no complications occurred. Results Eight patients were stupor or coma when they accepted therapy in our study, and two patients had transtentorial herniation. Eight of eleven patients experienced excellent or good clinical outcomes, and three patients died. The duration of follow -up ranged from 10 to 32 months （mean 21 months） , MRI/MRV showed the affected sinuses smoothly in six patients, partially smoothly in 2 patients. No patient has a rethrombosis. Conclusions The patient with serious CVST can be rapidly fatal only by routine therapy. Rhcolytic thrombectomy with AngioJet catheter or micro - balloon combined with intrsinus rt - PA thrombolysis can rapidly recanalize the affected dural sinuses in patients with CVST. It is a safe and effective endovascular method for high - risk patient with CVST.