脑静脉(窦)血栓的影像学特点与血管内治疗

目的探讨脑静脉(窦)血栓的影像学特点和经血管内治疗的疗效。方法对139例以顽固性头痛、头闷和颅内出血为主要症状的患者,采用头部MR和脑血管造影检查确立诊断,并施行经颈内动脉、静脉窦内接触性溶栓或静脉窦内支架血管成形术并协同长期抗凝治疗。结果治疗前MR检查显示颅内出血和静脉(窦)内血栓形成;脑血管造影检查可见脑静脉明显扩张、瘀滞,脑动脉至静脉窦间的血液循环时间显著延长(>11s),尤其静脉期(>5s)。治疗后130例患者临床症状迅速改善,治疗有效率达93.5%(130/139);并发症发生率0.7%(1/139);病死率2.2%(3/139)。对92例患者随访3个月～7年,1例死亡,91例疗效稳定,无明显复发。结论脑静脉(窦)血栓形成的主要病理表现为静脉回流障碍和血流动力学改变,通过脑血管造影检查可确定诊断;连续应用纤溶药物和长期抗凝治疗可获显著效果。

Imaging characteristics thrombosis in cerebral veins (sinuses) and endovascular treatment

Objective To study the imaging characteristics of thrombosis in cerebral veins(sinuses)and the effects of endovacular therapy.Methods One hundred and thirty-nine patients with main symptoms of intractable headache,oppression and intracranial hemorrhage were diagnosed by MRI and DSA,and treated by thrombolysis via carotid arteries and sinuse,or stent angio plasty in sinuses,combined with long-term anti-coagulation therapy.Re sults The MRI and DSA were performed in139and89patients respectiaely.Pre-treatment MRI demonstrated intracranial hemorrhage and thrombosis in veins(sinuses);DSA showed signifi-cant dilation of cerebral veins and stasis of blood.The circulating time from cerebral arteries to sinus remark-ably prolonged(>11s)especially in venous period(>5s).The clinical symptoms improved rapidly after thrombolysis or stent angioplasty and anticoagulation therapy,the effective rate reached93.5%(130/139).In these patients the morbidity rate was0.7%(1/139),and mortality was2.2%(3/139).Of 92cases followed up from3months to7years,no obvious recurrence but steady therapeutic effect were found in91cases,and one died.Con clusion The principal pathological manifestations of thrombosis in cerebral veins(sinuses)are ve-nous backflow obstruction and hemodynamic change;diagnosis can be confirmed by DSA.Significant effect will be obtained by continuous thrombolytic and long term anticoagulation therapy.It is important to prerent from the complication of cerebral hemorhage resulted in over thrombolysis and inapprofrriate anticoagulation approach.[