AngioJet流变溶栓抽栓术治疗颅内静脉窦血栓形成三例效果分析并文献复习

AngioJet rheolytic thrombectomy for cerebral venous sinus thrombosis:effect analysis of three case reports and literature review

目的探讨AngioJet流变溶栓抽栓术在治疗颅内静脉窦血栓形成(CVST)的安全性及可行性。方法连续纳入2019年12月至2020年6月福建省漳州市医院脑血管病介入科接受Angiojet流变溶栓抽栓术治疗的3例CVST患者的临床和影像学资料并进行回顾性分析,并结合AngioJet流变溶栓抽栓术治疗CVST的相关文献进行复习。临床资料包括患者的神经功能缺损程度、意识状态,影像学资料包括头部MR静脉成像(MRV)、DSA。3例患者均使用6 F AngioJet流变溶栓导管,且溶栓抽栓术前均予皮下注射低分子肝素钠100 U/kg,2次/d,抗凝治疗1~7 d。对AngioJet流变溶栓抽栓治疗的安全性进行评估,包括静脉破裂致颅内出血、穿刺点假性动脉瘤。术后2周对患者进行头部MRV+增强MR,采用改良心肌梗死溶栓(mTIMI)分级对静脉窦再通程度进行评估,mTIMI分级2级表示部分再通,mTIMI分级3级表示完全再通,以mTIMI分级≥2级为成功再通。术后90 d,通过电话或门诊的方式对患者进行临床随访,以改良Rankin量表(mRS)评分≤2分为预后良好。以“血管内治疗”“流变溶栓抽栓术”“脑静脉窦血栓”为中文主题词,在万方医学、维普、中国知网数据库中检索;以“Angiojet Rheolytic Thrombectomy”“Cerebral Venous Sinus Thrombosis”“Endovascular Treatment Therapy”为英文主题词,在PubMed数据库中检索。检索日期自1999年1月1日至2020年10月30日。结果3例均完成了AngioJet流变溶栓抽栓术,术后造影显示脑静脉窦显影完全再通2例,部分再通1例。从AngioJet流变溶栓导管到达靶静脉窦至静脉窦再通时间为28~56 min,中位时间为30 min;术后均未发生颅内出血,临床症状均得到缓解。3例患者于术后2周完成了临床及影像学随访,MRV提示静脉窦完全再通。3例患者随访时间分别为3、5、9个月,中位随访时间5.3个月。术后90 d,2例患者mRS评分为0分,1例患者mRS评分为1分。1999年1月1日至2020年10月30日,PubMed检索到16篇文献,万方医学、维普、中国知网数据库中未搜索到相关报道。16篇文献中共67例CVST患者接受了AngioJet流变溶栓抽栓术治疗。结论初步应用分析显示,可尝试将6 F AngioJet流变溶栓抽栓术作为CVST血管内治疗的一种方法。由于样本量较少,缺少长期随访的结果,本研究结果有待进一步验证。

Objective To investigate the safety and feasibility of AngioJet rheolytic thrombectomy in treating cerebral venous sinus thrombosis(CVST).Methods Clinical and imaging data of consecutive 3 patients with CVST admitted to Cerebrovascular-interventional Department of Zhangzhou Hospital of Fujian Province and received AngioJet rheolytic thrombectomy from December 2019 to June 2020 were retrospectively analyzed.Also,literatures about CVST treated by AngioJet rheolytic published were reviewed.Clinical data included neurological deficit and consciousness state;image data included brain MR venography(MRV)and DSA.6 F AngioJet rheolytic catheter was used in all three cases,and low-molecular-weight heparin sodium was administrated subcutaneously at a dose of 100 U/kg,twice a day for 1-7 days before rheolytic thrombectomy.Assessment of safety of AngioJet rheolytic thrombectomy was performed via event of intracranial hemorrhage(ICH)and pseudoaneurysm of puncture site.Brain MRV and enhanced MR were performed 2 weeks after procedure.The modified thrombolysis in myocardial infarction(mTIMI)was used to assess the recanalization of venous sinus,with mTIMI grade 2 defined as partial recanalization,mTIMI grade 3 as complete recanalization and mTIMI≥grade 2 as successful recanalization.Clinical follow-up was performed based on telephone or outpatient interview.The modified Rankin scale(mRS)≤2 was defined as good prognosis.Literature search was conducted based on databases of Wanfang data,CQVIP,CNKI,the key words in Chinese were“endovascular therapy”“rheolytic thrombolysis”“cerebral venous sinus thrombosis”,and on PubMed using the MeSH of“Angiojet Rheolytic Thrombectomy”“Cerebral Venous Sinus Thrombosis”“Endovascular Therapy”.Publication time was restricted from January 1,1999 to October 30,2020.Results All 3 patients with CVST underwent AngioJet rheolytic thrombectomy,with complete recanalization of venous sinus in 2 patients and partial recanalization in 1 patient.Duration from the AngioJet rheolytic catheter arrival of target sinus to recanalization of occlude sinus ranged from 28 minutes to 56 minutes,with the median time of 30 minutes;no post-operative ICH occurred.Neurological improvement was observed in all patients.Clinical and imaging follow-up was performed 2 weeks after procedure,and complete recanalization of target sinus was observed on MRV.The follow-up time of 3 patients was respectively 3,5 and 9 months,with the median time of 5.3 months.The 90-day mRS was 0 in two patients,and 1 in one patient.From January 1,1999 to October 30,16 studies were identified from Pubmed database but none from Wanfang data,CQVIP and CNKI.All 67 patients from 16 studies received AngioJet rheolytic thrombectomy.Conclusions Preliminary analysis showed rheolytic thrombectomy via 6F AngioJet rheolytic catheter maybe a feasible technique in treating CVST.Due to the small sample and lack of long-term follow-up,the results need to be further verified.