Solitaire支架半释放保护技术联合局部溶栓治疗重型颅内静脉窦血栓形成临床研究

Clinical Study of Solitaire Stent Semi-Release Protection Technique Combined with Local Thrombolysis in the Treatment of Severe Intracranial Venous Sinus Thrombosis

目的:探索Solitaire支架半释放保护(Solitaire stent-retriever half-release protection,SHARP)技术联合局部溶栓治疗重型颅内静脉窦血栓形成(Cerebral venous sinus thrombosis,CVST)临床价值。方法:整理我院2016年4月至2020年4月收治的143例重型CVST患者的临床资料,按照其治疗方案,将接受抗凝+局部溶栓治疗的74例患者纳入对照组,将接受抗凝+局部溶栓+SHARP技术取栓治疗的69例患者纳入研究组。对比两组患者溶栓治疗时间、住院时间、血管再通情况、并发症发生情况,以及治疗前后Glasgow昏迷量表(Glasgow coma scale,GCS)、Glasgow结局量表(Glasgow outcome scale,GOS)、改良Rankin量表(Modified rankin scale,mRS)评分,凝血纤溶功能变化,并根据治疗后6个月mRS评分评价患者预后。结果:研究组溶栓治疗时间低于对照组,差异有统计学意义(P<0.05)。研究组血管再通率为95.65%,高于对照组的77.03%,差异有统计学意义(P<0.05)。研究组并发症发生率为4.35%,对照组并发症发生率为18.92%,研究组并发症发生率低于对照组,差异有统计学意义(P=0.007)。两组出院前1d GCS评分、GOS评分均较治疗前升高,mRS评分均较治疗前下降;研究组出院前1d GCS评分、GOS评分升高值均高于对照组,其mRS评分降低值大于对照组,差异有统计学意义(P<0.05)。两组出院前1d APTT、PT、TT均较治疗前升高,FIB、D-D较治疗前下降;研究组出院前1d APTT、PT、TT升高值均高于对照组,其FIB、D-D降低值均大于对照组,差异有统计学意义(P<0.05)。两组患者均获得有效随访。术后6个月,研究组预后良好率为65.22%,高于对照组的32.43%,差异有统计学意义(P=0.001)。结论:在抗凝及局部溶栓的基础上,联合SHARP技术治疗重型CVST能够缩短溶栓时间、提高血管再通率、降低并发症发生率并改善患者预后。

Objective:To explore the clinical value of Solitaire stent-retriever half-release protection(SHARP)combined with local thrombelysis in the treatment of severe intracranial sinus thrombosis(CVST).Methods:The clinical data of 143 patients with severe CVST admitted to our hospital from April 2016 to April 2020 were collected.According to the treatment protocols,74 patients who received anticoagulation+local thrombolysis were included in the control group,and 69 patients who received anticoagulation+local thrombolysis+SHARP technique for thrombolysis were included in the study group.The duration of thrombolytic therapy,length of hospital stay,recanalization,occurrence of complications,Glasgow Coma Scale(GCS),Glasgow Outcome Scale(Glasgow Outcome Scale)and Coagulation and fibrinolysis function before and after treatment were compared between the two groups.GOS(GOS),Modified Rankin Scale(mRS)scores before and after treatment were compared between the two groups.And the prognosis of patients was evaluated according to mRS score at 6 months after treatment.Results:The duration of thrombolytic therapy in the study group was lower than that in the control group,the difference was statistically significant(P<0.05).The revascularization rate of the study group was 95.65%,higher than the control group at 77.03%,the difference was statistically significant(P<0.05).The complication rate in the study group was 4.35%,and 18.92%in the control group.The complication rate in the study group was lower than that in the control group,and the difference was statistically significant(P=0.007).The GCS score and GOS score 1 d before discharge in both groups increased and the mRS score decreased compared with those before treatment.The increase of GCS score and GOS score in the study group 1 day before discharge was higher than that in the control group,and the decrease of mRS score was higher than that in the control group,and the difference was statistically significant(P<0.05).In both groups,APTT,PT and TT were all higher and FIB and D-D were lower 1 d before discharge than before treatment;in the study group,APTT,PT and TT were all higher and FIB and D-D were all lower 1 d before discharge than in the control group.Patients in both groups were effectively followed up.At 6 months postoperatively,the good prognosis rate was 65.22%in the study group,higher than that of 32.43%in the control group,with a statistically significant difference(P=0.001).Conclusion:On the basis of anticoagulation and local thrombolysis,SHARP technique can shorten the thrombolysis time,improve the revascularization rate,reduce the incidence of complications and improve the prognosis of patients with severe CVST.