中间导管远端抽吸技术在重型颅内静脉窦血栓形成血管内治疗中的应用  

Application of distal aspiration procedure with intermediate catheter in the endovascular treatment of severe cerebral venous sinus thrombosis

作　　者：付晓杰 权涛[1] 袁永杰 王子博[1] 王丽君[1] 徐浩文[1] 管生[1] Fu Xiaojie;Quan Tao;Yuan Yongjie;Wang Zibo;Wang Lijun;Xu Haowen;Guan Sheng(Neurointerventional Department,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院神经介入科,郑州450000

出　　处：《中华神经外科杂志》2024年第11期1092-1097,共6页Chinese Journal of Neurosurgery

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190076)。

摘　　要：目的探讨中间导管远端抽吸技术在重型颅内静脉窦血栓形成(CVST)血管内治疗中的可行性、安全性及有效性。方法纳入2016年1月至2021年12月于郑州大学第一附属医院神经介入科接受中间导管远端抽吸技术治疗的重型CVST患者, 共37例。回顾性分析技术成功率、静脉窦再通情况、手术相关并发症。随访临床和影像学预后;临床预后评估采用改良Rankin量表评分(mRS), 0~2分为预后良好, ≥3分为预后不良。结果 37例患者中, 中间导管远端抽吸技术的成功率为97.3%(36例), 1例(2.7%)仅行静脉窦置管溶栓。术后即刻, 静脉窦完全再通6例(16.2%), 部分再通30例(81.1%), 1例(2.7%)未再通。术后共5例(13.5%)患者发生手术相关并发症, 1例(2.7%)为静脉窦穿孔。4例(10.8%)患者发生脑疝, 其中1例(2.7%)同时发生右侧股静脉血栓形成;3例(8.1%)死于脑疝。存活的34例患者术后中位随访时间为6(3~8)个月。随访期内, 1例CVST复发。随访末期, mRS 0~2分32例、3分2例;37例患者总体预后良好率为86.5%(32/37)。29例患者行影像学随访, 其中25例(86.2%)静脉窦再通良好, 4例(13.8%)未完全再通。结论中间导管远端抽吸技术治疗重型CVST技术可行, 相对安全、有效。Objective To explore the feasibility,safety and effectiveness of distal aspiration procedure with intermediate catheter in the endovascular treatment of severe cerebral venous sinus thrombosis(CVST).Methods This study enrolled a total of 37 patients with severe CVST who underwent the distal aspiration procedure with intermediate catheter in the Neurointerventional Department,First Affiliated Hospital of Zhengzhou University from January 2016 to December 2021.A retrospective analysis was conducted on the technical success rate,vein sinus recanalization and procedure-related complications.Clinical and imaging outcomes were followed up.The modified Rankin scale(mRS)score was used for clinical follow-up,with a score of o-2 indicating good outcome and a score of≥3 indicating poor outcome.Results Among the 37 patients,the success rate of the distal aspiration with intermediate catheter was 97.3%(36 patients),and 1 patient(2.7%)only underwent venous sinus thrombolysis.Immediate postoperative angiography showed that the venous sinus was completely recanalized in 6 cases(16.2%),partially recanalized in 30 cases(81.1%),and 1 case(2.7%)was not recanalized.A total of 5 cases(13.5%)experienced procedure-related complications after surgery,and 1 case(2.7%)suffered from venous sinus perforation;4 cases(10.8%)developed cerebral herniation,of which 1 case(2.7%)also developed right femoral vein thrombosis,3 patients(8.1%)died of cerebral herniation.The median follow-up time after surgery for the 34 surviving patients was 6 months(3-8 months).During the follow-up period,1 case of venous sinus thrombosis recurred.At the end of follow-up,32 cases had mRS of 0-2 points and 2 cases had mRS of 3 points;the overall good outcome rate of 37 patients was 86.5%(32/37).Twenty-nine patients underwent imaging followup,of which 25(86.2%)had good sinus recanalization and 4(13.8%)had incomplete recanalization.Conclusion Distal aspiration procedure with intermediate catheter is a technically feasible,relatively safe,and effective method in the en

关 键 词：窦血栓形成 颅内 血管内操作 治疗结果 颅内中间导管 

分 类 号：R651.12[医药卫生—外科学]