颅内静脉窦血栓形成的血管内治疗  

Endovascular treatment for intracranial dural sinus thrombosis

作　　者：吉训明[1] 凌锋[1] 缪中荣[1] 张鸿祺[1] 张鹏[1] 李慎茂[1] 朱凤水[1] 支兴龙[1] 宋庆斌[1] 秦晓红[1] 牛香美[1] 张虹[1] 朱雪铮[1] 

机构地区：[1]北京市脑血管病中心 首都医科大学宣武医院介入放射诊断治疗中心,100053

出　　处：《中国脑血管病杂志》2004年第3期100-105,共6页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨经血管内途径治疗颅内静脉窦血栓形成的疗效和安全性. 方法对 12例难治性颅内静脉窦血栓形成的患者进行了静脉接触性溶栓、机械性破栓、颈动脉溶栓和静脉窦内支架置入多途径联合血管内治疗.所有患者均有颅内静脉窦血栓形成的危险因素.术后积极治疗原发病,抗凝治疗 6个月.术后随访 17～ 29个月,平均 23个月. 结果 12例患者均接受了经静脉途径溶栓治疗,其中 10例患者同时接受机械性血栓切割治疗,另有 2例患者同时接受经颈动脉途径溶栓治疗.尿激酶使用总量 80万～ 290万 U,每例患者平均每天剂量低于 100万 U.出院时,所有患者的闭塞静脉窦均获再通,临床症状改善,颅内压恢复.术后积极治疗原发病和抗凝治疗 6个月,平均随访 23个月,无一例血栓再形成.回顾文献,经血管内途径治疗颅内静脉窦血栓形成临床症状改善率为 92%,死亡率为 5%本组患者的临床症状改善率为 93%,病死率为 3.8%.联合血管内治疗组与单一血管内治疗组临床症状改善率差异无显著性意义 (χ 2=1.27,P>0.05). 结论血管内治疗颅内静脉窦血栓是安全、有效的治疗手段.Objective The authors reviewed the experience of endovascular treatment for 12 patients with intracranial dural sinus thrombosis to evaluate the efficacy and risk of endovascular thrombolysis for intracranial du-ral sinus thrombosis. Methods 12 patients with intracranial dural sinus thrombosis confirmed by CT, MRI, MRV and/or DSA were treated with multiple modality endovascular thrombolysis including intravenous thrombolysis, mechanical thrombus maceration, intraarterial thrombolysis and stenting. After thrombolysis, treatment aimed at the primary diseases was continued and warfarin was used for 6 months. The patients were followed-up for 17 -29 months (mean = 23 months). Results All of the 12 patients underwent transvenous thrombolysis. 10 underwent combined transvenous thrombolysis, clot maceration and transartenal infusion of urokinase, and the other 2 underwent transvenous infusion of urokinase combined with transarterial infusion of urokinase. The infusion dose of urokinase was 800 000 - 2 900 000 U, the average dose of urokinase was less than 1 000 000 U per day. All patients achieved recanalization of sinuses as confirmed on postprocedural angiography, MRI and MRV studies were taken prior to hospital discharge. All the patients had improved neurologieally. During follow-up, no patient recurred. Reviewing literatures, it was found that endovascular thrombolysis with intracranial dural sinus thrombosis could get consistent clinical improvement and overall improvement rate was 92% , and the mortality rate is 5% . The improvement rate of our group was 93% , and mortality rate was 5% . There was no significant difference between combined endovascular treatment and single endovascular treatment (X2 = 1. 27, p>0. 05). Conclusion Endovascular treatment is an effective and safe measure for potentially catastrophic intracranial dural sinus thrombosis.

关 键 词：颅内静脉窦 血栓形成 血管内治疗 支架置入 

分 类 号：R743[医药卫生—神经病学与精神病学]