血管内介入方法治疗重症颅内静脉窦血栓

Endovascular interventional treatment for severe cerebral venous sinus thrombosis

目的探讨应用血管内介入方法治疗重症颅内静脉窦血栓(CVST)的有效性和安全性。方法回顾性分析2009年12月~2012年4月收治的8例重症CVST患者。GCS 4~9分,平均8.3±2.7分。接受血管内治疗时2例已发生脑疝。由MRI、MRV和/或DSA确诊为CVST。均在全麻下行局部破栓结合经微导管静脉窦内局部rt-PA溶栓,术中及术后留置微导管的3~5 d内,每天予rt-PA20 mg。术后结合肝素化及降颅压对症治疗。术后症状随访及MRV随访3 m^2 y。结果 1例死亡。7例恢复良好,GCS评分均恢复到15分,1例情感障碍,2例轻度神经功能障碍。影像学随访示责任病灶完全再通5例,部分再通2例。症状无复发。结论对于重症CVST患者,应用血管内局部破栓结合窦内rt-PA溶栓是安全有效的。

Objective To assess the effectiveness and safety of endovascular interventional therapy for severe cere- bral venous sinus thrombosis（CVST）. Methods Retrospectively analyze 8 patients with severe CVST confirmed by CT, MRI,MRV and/or DSA,who were treated in our department from Dec. 2009 to Apr. 2012. The Glasgow coma scale（GCS） was from 4 to 9, mean（8.3 ± 2.7 ）score. Two patients were with cerebral hernia when they underwent endovascular inter- ventional treatment. The mechanical clot disruption combined with intrasinus thrombolytic therapy using rt-PA was per- formed in general anesthesia,20 mg rt-PA was infused into sinus through micro-catheter. The micro-catheter was reserved in sinus for 3-5 days after the operation and 20 mg rt-PA was infused per day. During this period, heparin therapy and intra- cerebral pressure control were performed. The follow-up was performed 3 months to 2 years after the operation. Result 1 patient died. The other 7 patients recovered well. On discharge,the GCS of all the 7 patients recovered to 15＇ ;1 patient was complicated with affective disorder,2 patients were with mild neurological defect. MRI and MRV followed up showed 5 cases were with complete recanalization of criminal sinus, 2 cases were with partial recanalization. No recurrence of the symptoms was found. Conclusion For the patients with severe CVST,mechanical thrombus destruction combined with in- trasinus thrombolytic therapy using rt-PA is safe and effective.