血管内介入治疗脑静脉窦血栓形成的临床研究

目的：回顾性分析2005年10月—2010年10月21例脑静脉窦血栓形成（CVST）患者的血管内介入治疗情况，探讨手术适应证，操作技术及手术相关并发症的应对措施，评价动静脉联合溶栓术治疗CVST的有效性及安全性。方法：①21例病例均行CTV或MRV检查并经DSA全脑血管造影确诊的患者，记录每位患者的发病时间、介入手术前的治疗情况及疗效。②血管内介入治疗：经皮穿刺股动脉、股静脉置鞘，全程静脉肝素化后给予动、静脉联合溶栓治疗，术中导丝、导管及球囊等辅助碎栓。③探讨手术时期与疗效之间的关系，总结手术并发症及应对措施，评价手术疗效及安全性。④随访。结果：21例患者从发病到手术治疗时间为1~10周，平均2.7周，术前均有过降颅压及对症治疗，有2例接受过低分子肝素治疗，疗效均不明显。21例患者入院后12~48 h内接受血管内介入治疗，给予动脉溶栓、脑静脉窦内接触溶栓、塑形导丝及球囊辅助机械碎栓及微导管留置接触溶栓等联合处理，14例完全再通，6例部分再通，1例无变化。疗效与病程有关，病程越短疗效越显著。2例出现手术相关并发症，1例碎栓球囊破裂，无特殊处理，1例浅静脉破裂出血患者停止手术给予对症处理，于1周后二次手术溶栓治愈。21例患者总有效率为95.2%（20/21），手术相关并发症发生率为9.5%（2/21）。所有患者随访半年至2年，均存活，其中1例无变化患者的视力完全丧失并伴神经功能损害，日常生活能力严重受限。结论：血管内介入溶栓治疗CVST是安全有效的；适应证是病程在8周以内的患者，病程越短疗效越显著，多种方法联合治疗能让病程超过2月的部分患者获益；并发症主要与操作有关。

Clinical study on endovascular treatment for thrombosis of intracranial venous sinus

Objective： To observe the effect and safety of combined intravenous and intra-arterial thrombolysis therapy for intracranial venous sinus thrombosis （CVST）. Twenty-one patients with CVST who accepted endovascular therapy were analysed retrospectively. Methods： Twenty-one patients diagnosed CVST with CTA, MRA and/or DSA. The time of onset of illness, the treatment history and the curative effect before the therapy were recorded for each patient. Then each of them were treated with multiple modality of endovascular thrombolysis including intra-arterial thrombolysis, intravenous thrombolysis, mechanical thrombus maceration, lied up micro-catheter thrombolysis. The relationship between the operative time and the curative effect, complication and treatment were analysed. Results： CVST reopened in 14 cases, partly reopened in 6 cases and no effect in 1 case. Balloon ruptured in 1 case, in one patient the cerebral superficial vein ruptured without get the surgical repaired at that time, and one week later ruptured again. The effective rate was 95.2%, the rate of complications of the therapy was 9.5%. Follow,up for 1-2 years, no patient recurred except one case. Conclusions： The endovascular therapy is safe and effec- tive in treating patients with CVST, but the course of disease must be within 8 weeks. The shorter the course, the result will be better. Most complications are due to manipulating technique.