尿激酶联合替罗非斑在颅内静脉窦血栓形成介入性治疗中的应用

Interventional thrombolysis with Urokinase and Tirofiban in patients with cerebral venous sinus thrombosis

目的探讨尿激酶联合替罗非斑血管内溶栓治疗颅内静脉窦血栓形成（CVST）的疗效和安全性。方法广州军区武汉总医院神经外科自2009年1月至2011年1月行尿激酶联合替罗非斑经微导管选择性静脉窦内溶栓、机械性碎栓治疗9例重症CVST患者，分析其临床资料和疗效。结果出院前8例患者脑脊液（CSF）压力正常，DSA检查显示7例患者静脉窦主干通畅，皮层静脉和深静脉恢复正常。1例部分再通，皮层静脉部分代偿。术中和术后未发生手术操作相关的并发症：出院时8例患者症状、体征得到改善，其中头痛消失7例，遗留轻度头痛1例。1例死亡。结论尿激酶联合替罗非斑经微导管选择性静脉窦内溶栓治疗是CVST安全、有效的治疗手段。

Objective To evaluate the efficacy and risk of endovascular thrombolysis with Urokinase and Tirofiban in patients with cerebral venous sinus thrombosis （CVST）. Methods Nine patients with severe CVST were performed selective intravenous sinus Urokinase and Tirofiban thrombolysis combined with mechanical thrombus maceration in our hospital from January 2009 to January 2011; their clinical data and treatment efficacy were analyzed. Results Normal cerebrospinal fluid （CSF） pressure was noted in 8 patients before discharging from the hospital; DSA indicated that 7 achieved complete recanalization of main branch of the venous sinus, cortical veins and deep vein. Only 1 achieved recanalization of sinuses partly, and partial compensation was noted in the cortical veins. No operation-related complication was noted during and after the surgery. After thrombolysis, symptoms and signs of 8 patients improved obviously, and headache disappeared in 7 of them with only mild degree in 1; 1 patient died. Conclusion Intravenous sinus Urokinase and Tirofiban thrombolysis is an effective and safe method for patients with potentially catastrophic intracranial dural sinus thrombosis.