【摘要】 目的探讨应用血管内介入方法治疗重症颅内静脉窦血栓(CVST)的有效性和安全性。方法回顾性分析2009年12月~2012年4月收治的8例重症CVST患者。GCS 4~9分,平均8.3±2.7分。接受血管内治疗时2例已发生脑疝。由MRI、MRV和/或DSA确诊为CVST。均在全麻下行局部破栓结合经微导管静脉窦内局部rt-PA溶栓,术中及术后留置微导管的3~5 d内,每天予rt-PA20 mg。术后结合肝素化及降颅压对症治疗。术后症状随访及MRV随访3 m~2 y。结果 1例死亡。7例恢复良好,GCS评分均恢复到15分,1例情感障碍,2例轻度神经功能障碍。影像学随访示责任病灶完全再通5例,部分再通2例。症状无复发。结论对于重症CVST患者,应用血管内局部破栓结合窦内rt-PA溶栓是安全有效的。更多还原

【Abstract】 Objective To assess the effectiveness and safety of endovascular interventional therapy for severe cerebral venous sinus thrombosis( CVST). Methods Retrospectively analyze 8 patients with severe CVST confirmed by CT、MRI、MRV and /or DSA,who were treated in our department from Dec. 2009 to Apr. 2012. The Glasgow coma scale( GCS)was from 4 to 9,mean( 8. 3 ± 2. 7) score. Two patients were with cerebral hernia when they underwent endovascular interventional treatment. The mechanical clot disruption combined with intrasinus thrombolytic therapy using rt-PA was performed in general anesthesia,20 mg rt-PA was infused into sinus through micro-catheter. The micro-catheter was reserved in sinus for 3-5 days after the operation and 20 mg rt-PA was infused per day. During this period,heparin therapy and intracerebral pressure control were performed. The follow-up was performed 3 months to 2 years after the operation. Result 1patient died. The other 7 patients recovered well. On discharge,the GCS of all the 7 patients recovered to 15’; 1 patient was complicated with affective disorder,2 patients were with mild neurological defect. MRI and MRV followed up showed 5cases were with complete recanalization of criminal sinus,2 cases were with partial recanalization. No recurrence of the symptoms was found. Conclusion For the patients with severe CVST,mechanical thrombus destruction combined with intrasinus thrombolytic therapy using rt-PA is safe and effective.更多还原