血管内机械血栓切除术联合持续窦内溶栓治疗严重出血性脑静脉窦血栓形成:病例系列研究

Endovascular mechanical thrombectomy combined with continuous intrasinus thrombolysis for the treatment of severe hemorrhagic cerebral venous sinus thrombosis: a case series study

目的探讨血管内机械血栓切除术(endovascular mechanical thrombectomy,EMT)联合静脉窦内持续溶栓治疗严重出血性脑静脉窦血栓形成(cerebral venous sinus thrombosis,CVST)的可行性及安全性。方法回顾性分析2019年3月至2020年2月在北京天坛医院接受EMT联合窦内持续尿激酶溶栓治疗的连续5例严重出血性CVST患者的临床及影像学资料。结果5例患者平均年龄39岁(范围19~65岁);男性2例,女性3例;3例有明确发病危险因素。4例患者有2个以上静脉窦受累,共10支CVST受累血管,受累静脉窦血栓负荷大、病灶体积大,临床表现重。EMT前平均肝素抗凝治疗时间为2.3 d(范围0.5~7 d),窦内溶栓平均持续时间为64 h(范围30~95 h)。治疗后8支血管再通,其中1支完全再通,7支部分再通。实现血管再通的4例患者长期临床转归良好(改良Rankin量表评分:3个月时0~2分,1年时0~1分)。1例患者未能实现血管再通,并因颅内高压行去骨瓣减压术,1年后遗留偏身瘫痪。5例患者均未发生手术相关并发症。结论EMT联合持续静脉窦内溶栓治疗是严重出血性CVST患者的潜在治疗手段。

Objective To investigate the feasibility and safety of endovascular mechanical thrombectomy(EMT)combined with continuous intrasinus thrombolysis for the treatment of severe hemorrhagic cerebral venous sinus thrombosis(CVST).Methods The clinical and imaging data of 5 consecutive patients with severe hemorrhagic CVST who received EMT combined with continuous intrasinus urokinase thrombolysis in Beijing Tiantan Hospital from March 2019 to February 2020 were retrospectively analyzed.Results The average age of 5 patients was 39 years(range,19-65 years).Two were males and 3 were females.Risk factors associated with CVST were identified in 3 patients.Four had more than two venous sinuses involved,with a total of 10 blood vessels affected by CVST.The affected venous sinus thrombus burden was high,the lesion volume was large,and the clinical manifestations were severe.The average duration of heparin anticoagulation therapy before EMT was 2.3 d(range,0.5-7 d),and the average duration of intrasinus thrombolysis was 64 h(range,30-95 h).After treatment,1 vessel was completely recanalized and 7 vessels were partially recanalized.Four patients who achieved recanalization had good long-term clinical outcomes(modified Rankin Scale score:0-2 at 3 months,0-1 at 1 year).One patient failed to achieve recanalization and underwent decompressive craniectomy due to intracranial hypertension,had residual hemiparesis at 1-year follow-up.No procedure-related complications occurred.Conclusion EMT combined with continuous intrasinus thrombolysis is a potential treatment option for patients with severe hemorrhagic CVST.