高分辨率磁共振黑血血栓成像辅助抗凝药联合血管内治疗对亚急性和慢性脑静脉窦血栓形成疗效初探

A preliminary study on the efficacy of anticoagulants combined with endovascular treatment for subacute and chronic cerebral venous sinus thrombosis assisted by high resolution magnetic resonance black-blood thrombus imaging

目的 探讨在高分辨率磁共振黑血血栓成像(MRBTI)辅助下,抗凝药联合血管内治疗方案对亚急性和慢性脑静脉窦血栓形成(CVST)的有效性和安全性。方法与结果 回顾分析2019年1月至2021年1月天津市环湖医院收治的15例CVST患者临床资料,通过高分辨率MRBTI快速识别病程分期,在系统性抗凝治疗基础上实施血管内治疗。结果显示,处于亚急性期者10例、慢性期者5例,治疗后有4例脑静脉窦完全再通、余11例部分再通;2例发生并发症(颅内血肿扩大1例、术中微导丝穿透直窦壁1例),待病情平稳后继续行接触性溶栓治疗。微导管留置时间平均为(6.27±0.21)d、住院时间平均为(11.53±1.30)d。患者出院时意识障碍改善[出院时Glasgow昏迷量表(GCS)评分(13.67±2.02)分对入院时GCS评分(11.67±2.13)分;t=9.165,P=0.000],术后6个月时神经功能改善[术后6个月改良Rankin量表(mRS)中位评分1(0,2)分对入院时mRS中位评分3(2,4)分;Z=-3.624,P=0.000]。结论高分辨率MRBTI可以有效识别亚急性和慢性CVST患者,系统性抗凝治疗联合血管内治疗可于短时间内减轻脑静脉窦内血栓负荷、改善症状,是一种安全、有效的首选治疗方案。

Objective endovascular treatment for subacute and chronic cerebral venous sinus thrombosis(CVST) under the assistance of high resolution magnetic resonance black-blood thrombus imaging(MRBTI).Methods and Results Neurosurgery of Tianjin Huanhu Hospital from January 2019 to January 2021. Preoperative high resolution MRBTI confirmed 15 patients with subacute and chronic CVST, and endovascular treatment was performed on the basis of systemic anticoagulant therapy. The results showed that 10 cases were in subacute stage and 5 cases were in chronic stage. After treatment, the venous sinus was completely recanalized in 4 cases and partially recanalized in 11 cases. Complications occurred in 2 cases(intracranial hematoma enlarged in one case, microguide wire penetrated straight sinus wall during surgery in one case), contact thrombolytic therapy was continued after the condition stabilized. The mean indwelling time of microcatheter in straight sinus was(6.27 ± 0.21) d and the mean length of hospital stay was(11.53 ± 1.30) d. The degree of impairment of consciousness [Glasgow Coma Scale(GCS) score] was improved at discharge [at discharge(13.67 ± 2.02) score vs. at admission(11.67 ± 2.13) score;t = 9.165, P = 0.000], the degree of neurological impairment [modified Rankin Scale(mRS) score] was improved 6 months after surgery [at 6 months after surgery 1(0, 2) score vs. at admission 3(2, 4) score;Z =-3.624, P = 0.000].Conclusions MRBTI is an effective technique to identify subacute and chronic CVST patients. For these patients, the combination of systemic anticoagulation and endovascular treatment can reduce venous sinus thrombosis load and improve symptoms in a short time, which is a safe, effective and preferred treatment.