脑静脉窦血栓或静脉窦狭窄患者血管腔内操作相关并发症分析  

Analysis of complications related to endovascular procedures for cerebral venous sinus thrombosis or venous sinus stenosis

作　　者：刘新峰[1] 吕斌[1] 张荣举[1] 杜志华[1] 曹向宇[1] 李宝民[1] 王君[1] Liu Xinfeng;Lyu Bin;Zhang Rongju;Du Zhihua;Cao Xiangyu;Li Baomin;Wang Jun(Department of Neurology,the First Medical Center of Chinese People′s Liberation Army General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心神经内科,北京100853

出　　处：《中国脑血管病杂志》2022年第1期35-42,64,共9页Chinese Journal of Cerebrovascular Diseases

基　　金：解放军总医院青年成长项目(QNC19029)。

摘　　要：目的分析脑静脉窦血栓及静脉窦狭窄血管腔内操作相关并发症。方法回顾性连续纳入2000年1月至2021年6月解放军总医院第一医学中心神经内科明确诊断的脑静脉窦血栓或静脉窦狭窄且接受脑静脉系统血管腔内操作的患者456例,腰椎穿刺示脑脊液压力≥250 mmH 2O,全脑DSA检查证实存在静脉窦狭窄(狭窄两端压力差≥10 mmHg)或静脉窦血栓形成。记录患者年龄、性别、主要临床症状、头部影像学检查结果及治疗过程。腔内操作方法包括脑静脉窦内溶栓、脑静脉窦测压、脑静脉窦支架置入,并发症发生的原因包括导丝导管穿刺损伤血管壁、支架状态异常所致的静脉回流障碍及其他,即血管穿孔性并发症(硬膜下出血、蛛网膜下腔出血、硬膜外血肿、腹膜后出血、股动脉假性动脉瘤)、回流障碍性并发症(急性支架内血栓形成、皮质静脉回流障碍)及静脉窦分隔,其中严重的急性并发症为急性硬膜下出血、蛛网膜下腔出血、急性支架内血栓形成、支架置入静脉窦分隔及支架术后皮质静脉回流障碍。于术后3~12个月进行门诊或电话随访,随访内容主要是头痛及视力变化情况。建议患者出院后6~12个月住院复查腰椎穿刺术、视力、视野及DSA检查,观察颅内静脉系统的变化。结果共纳入脑静脉窦血栓或静脉窦狭窄患者456例,其中男112例(24.6%),女344例(75.4%);平均年龄(39±9)岁;共完成血管内介入治疗术644例次,其中脑静脉窦内溶栓89例次,脑静脉窦测压274例次,脑静脉窦支架置入281例次。22例患者发生了操作相关并发症,其中1例患者出现了2个并发症(支架置入静脉窦分隔结构,并伴硬膜外出血),故全部操作相关并发症发生率为3.6%(23/644),其中严重的急性并发症包括蛛网膜下腔出血2例(0.3%)、硬膜下出血2例(0.3%)、支架置入静脉窦分隔2例(0.3%)、支架内急性血栓形成1例(0.2%)、皮质静脉回流障Objective To analyze endovascular operation related complications of cerebral venous sinus thrombosis or venous sinus stenosis.Methods From January 2000 to June 2021,a total of 456 patients with cerebral venous sinus thrombosis or stenosis confirmed by the Department of Neurology,the First Medical Center of Chinese People′s Liberation Army General Hospital,and who had received endovascular therapy of the cerebral venous system,were retrospectively and continuously enrolled.Whole-brain digital subtraction angiography examination confirmed the presence of venous sinus stenosis(pressure difference between the two ends of the stenosis≥10 mmHg)or venous sinus thrombosis.Age,gender,main clinical symptoms,head imaging results and treatment were recorded.Endovascular therapy methods include thrombolysis in cerebral venous sinus,manometry in cerebral venous sinus,and stenting in cerebral venous sinus.The causes of complications include vascular wall injury caused by guidewire catheter puncture,venous return obstruction caused by abnormal stenting status,and others including vascular perforation complications(subdural hemorrhage,subarachnoid hemorrhage,epidural hematoma,retroperitoneal hemorrhage,femoral artery pseudoaneurysm),drainage obstruction complications(acute stent thrombosis,cortical venous drainage disturbance)and venous sinus separation.Among them,the serious acute complications were acute subdural hemorrhage,subarachnoid hemorrhage,acute stent thrombosis,venous sinus separation after stenting,and cortical venous drainage disturbance after stenting.All patients were followed up 3 to 12 months postoperatively by outpatient visit or telephone for headache and visual acuity changes.It was recommended that patients be hospitalized 6 to 12 months after discharge for lumbar puncture,visual acuity,visual field and DSA examination to observe the changes of intracranial venous system.Results A total of 456 patients with cerebral venous sinus thrombosis or stenosis were included in this study,including 112 males(24.6%

关 键 词：颅内栓塞和血栓形成 窦血栓形成 颅内 手术中并发症 颅内高压 血管内治疗 脑静脉窦狭窄 脑静脉窦测压 

分 类 号：R743.3[医药卫生—神经病学与精神病学]