经血管内溶栓和支架成形治疗脑静脉窦闭塞

目的：介绍应用静脉窦内直接溶栓和支架成形治疗脑静脉窦闭塞的初步经验。方法：17例患者均经DSA证实为静脉窦内血栓形成。单一部位血栓3例,多发性血栓14例;脑动静脉循环时间均延长至13s以上。所有患者先采用血管内直接溶栓治疗,先在静脉窦内留置微导管5d,同时局部输入尿激酶150万U/d,并口服华法令3-5mg。其中4例经复查造影见静脉窦仍狭窄明显,再置放Smart支架进行窦内成形。结果：17例患者经静脉窦内接触性溶栓、支架成形术后静脉窦完全再通9例,部分再通8例。治疗后7例颅内压恢复正常,8例于术后7d内再次有不同程度的颅内压升高,经扶持抗凝后使颅内压恢复正常,仅2例颅内压高于280mmH2O。术后对患者随访3个月-5年,15例症状持续缓解。结论：对静脉窦血栓采用持续溶栓和支架成形可直接促进脑静脉血液因流,从而降低颅内压。

Endovascular thrombolysis and stent angioplasty for obliteration in cerebral venous sinuses

Objective To summarize the experience of treating the obliteration of the cerebral venous sinus in 17 patients by using direct thromblysis and stent angioplasty. Methods All 17 patients with thrombosis and stenosis of the venous sinus were confirmed by digital substract angiography. Of these 3 patients had thrombosis in a single sinus and 14 had thrombosis in multiple sinuses. The circulating time was prolonged for over 13 seconds. The micro-catheter was preserved in the sinus for 5 days, followed by infusion of urokinase 1 5 million units and oral wafarin 3-5 mg each day. Stent angioplasty was done for 4 patients with obvious stenosis of the venous sinus detected by DSA after thrombosis. Results After contact thrombosis and stent angioplasty in sinuses of the 17 patients, remarkable recanalization of obliterated sinuses was achieved. After treatment, intracranial hypertension pressure (ICP) returned to normal in 7 patients, and 8 thrombosis relapsed in different degree after 7 days. Anticoagulation was preseribed. Only 2 patients showed the ICP above 280 mm H 2O. No obvious relapse was found in 15 patients during the follow-up for 3-60 months. Conclusion Our results demonstrated that successive thrombolysis and stent angioplasty for occlusion and thrombosis of the venous sinus are effective in promoting drainage of cerebral venous blood and rapidly decreasing ICP.