血管内联合治疗出血性颅内静脉窦血栓形成的疗效

Endovascular combination therapy for hemorrhagic thrombosis in intracranial venous sinus

目的探讨血管内联合治疗出血性颅内静脉窦血栓形成的安全性及有效性。方法回顾性分析2019年3—11月苏州大学附属第一医院神经外科收治的8例急性或亚急性颅内静脉窦血栓形成患者,所有患者均表现为脑实质出血或伴有脑梗死。8例患者术中均联合应用机械碎栓、支架取栓、导管抽吸、球囊扩张、接触性溶栓等方案。1例患者因病情进展迅速,血管内治疗后行去骨瓣减压术。术后及随访时观察静脉窦的再通情况,并采用改良Rankin量表评分(mRS)评估患者的预后。结果8例患者均经CT静脉成像或磁共振静脉成像提示静脉窦部分再通后拔除微导管。术后患者均于静脉窦内留置微导管系统,留置时间为4~10 d,其中7例行3~8 d的接触性溶栓治疗,并规律应用抗凝药物治疗≥6个月。所有患者术后1周内均未见出血进展,闭塞的静脉窦均大部分再通;1个月内颅内出血吸收、水肿消退。8例患者予以对症治疗后均治愈出院,随访时间为6~15个月,未见静脉窦血栓复发及新发神经系统症状。术后6个月随访mRS,其中0分3例,1分3例,2分1例,3分1例。结论在规范抗凝治疗的基础上联合应用多种血管内治疗方案,可在短时间内减轻静脉窦内的血栓负荷,是治疗出血型颅内静脉窦血栓形成安全、有效的方法。

Objective To review the efficacy and experience of endovascular combination therapy for hemorrhagic thrombosis in intracranial venous sinus.Methods We retrospectively analyzed 8 patients with acute or subacute cerebral venous sinus thrombosis who were treated at Neurosurgical of Department,the First Affiliated Hospital of Soochow University from March 2019 to November 2019.All those cases had intracranial hemorrhage and some of them also suffered from cerebral ischemia simultaneously.All patients underwent endovascular combination therapy including mechanical thrombectomy,thrombus aspiration,balloon dilatation and catheter-directed thrombolysis.In 1 patient,the conditions deteriorated rapidly and decompressive craniectomy was performed following endovascular treatment.The patency of cerebral venous sinus was assessed post operation and at follow-up.The patients′outcomes were evaluated based on the modified Rankin scale(mRS).Results Microcatheter was removed in 8 patients when the patency of the venous sinus was confirmed by CTV or MRV reexamination.The micro-catheter system was reserved in intracranial venous sinus for 4-10 days after the operation.Seven of the patients underwent catheter-directed thrombolysis therapy for 3-8 days.Anticoagulant drug was used regularly for more than 6 months.None of the patients have progression of hemorrhage within 1 week after surgery,most of the occluded sinuses were re-opened.The intracranial hemorrhage was absorbed and the edema was also resolved within 1 month.Eight patients were cured and discharged after treatment,and the follow-up time was 6 to 15 months,with no recurrence of sinus thrombosis and new neurological symptoms.At 6-month follow-up post surgery,the mRS was 0 in 3 cases,1 in 3 cases,2 in 1 case,and 3 in 1 case.Conclusion Combined with conventional anticoagulant therapy,multiple endovascular treatment schemes could reduce the thrombus load in venous sinus in a short time and was effective and safe treatment of hemorrhagic thrombosis in intracranial venous sinus.