经血管内溶栓和支架成形治疗脑静脉窦闭塞
解放军总医院神经介入医学科 (100853)
【摘要】目的：介绍应用静脉窦内直接溶栓和支架成形治疗17例脑静脉窦。
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13 s以上。采用血管内直接溶栓时，先在静脉窦内留置微导管5 d，同时局部输入尿激酶150万U/d，并口服华法令3～5 mg。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、支架成形术后明显较术前完全再通9例，部分再通8例。治疗后7例颅压恢复正常，8例于术后7 d内再次有不同程度的颅内压升高，经持续抗凝后使疗效得以维持，仅2例颅压高于280 mmHg。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回流，从而降低颅内压。
, 百拇医药
【关键词】脑静脉窦 血栓 闭塞 溶栓 支架
Endovascular thrombolysis and stent angioplasty for occlusion in cerebral venous sinuses
LI Baomin, GUO Mei, LI Sheng WANG Maoqiang
Department of Interventioanl Radiology, General Hospital of PLA, Road, Beijing 100853, China.
【Abstract】Objective: Using direct thromblysis and stent angioplasty to treat the occlusion of cerebral venous sinuses in 17 cases were reported here. Methords: All of 17 cases with the thrombosis and stenosis in venous sinuses were confirmed by DSA (Digital substract angiography). There were 3 cases with thrombosis in single sinus and 14 cases with thrombosis in multiple sinuses. The circulating period was prolonged for over 13 seconds. The micro-catheter was preserved in sinus for 3 to 5 days and infused urokinase one million IU and oral wafarin 3-5 mg each day during treatment. The stent angioplasty was done for 4 cases with obvious venous sinus stenosis that were showed by DSA after post-thrombolysis. Results: After contact thrombolysis and stent angioplasty in sinuses among 17 cases, remarkable recanalization of occllusive sinuses compared with before in 9/17 cases and partial in 8/17 cases were achieved. After treatment, the ICP was returned to normal in 7/17 cases, 8/17 cases with relapse of thrombosis in different degree after 7 days kept for good state via the continued anticoagulation. There were only 2 cases with the ICP above 280 mmHg. No obvious relapse in 15/17 cases were found follow-up 3-60 months. Conclusion: The primary results of our group demonstrated that the successive thrombolysis and stent angioplasty for occlusion and thrombosis of venous sinuses are the effective and safe therapies which directly promoting drainage for cerebral venous blood and rapidly decreasing the ICP.
【Key words】Cerebral venous sinus Thrombosis Occlusive Thrombolysis Stent, 百拇医药(李宝民 郭梅 李生 王茂强)
【摘要】目的：介绍应用静脉窦内直接溶栓和支架成形治疗17例脑静脉窦。
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13 s以上。采用血管内直接溶栓时，先在静脉窦内留置微导管5 d，同时局部输入尿激酶150万U/d，并口服华法令3～5 mg。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、支架成形术后明显较术前完全再通9例，部分再通8例。治疗后7例颅压恢复正常，8例于术后7 d内再次有不同程度的颅内压升高，经持续抗凝后使疗效得以维持，仅2例颅压高于280 mmHg。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回流，从而降低颅内压。
, 百拇医药
【关键词】脑静脉窦 血栓 闭塞 溶栓 支架
Endovascular thrombolysis and stent angioplasty for occlusion in cerebral venous sinuses
LI Baomin, GUO Mei, LI Sheng WANG Maoqiang
Department of Interventioanl Radiology, General Hospital of PLA, Road, Beijing 100853, China.
【Abstract】Objective: Using direct thromblysis and stent angioplasty to treat the occlusion of cerebral venous sinuses in 17 cases were reported here. Methords: All of 17 cases with the thrombosis and stenosis in venous sinuses were confirmed by DSA (Digital substract angiography). There were 3 cases with thrombosis in single sinus and 14 cases with thrombosis in multiple sinuses. The circulating period was prolonged for over 13 seconds. The micro-catheter was preserved in sinus for 3 to 5 days and infused urokinase one million IU and oral wafarin 3-5 mg each day during treatment. The stent angioplasty was done for 4 cases with obvious venous sinus stenosis that were showed by DSA after post-thrombolysis. Results: After contact thrombolysis and stent angioplasty in sinuses among 17 cases, remarkable recanalization of occllusive sinuses compared with before in 9/17 cases and partial in 8/17 cases were achieved. After treatment, the ICP was returned to normal in 7/17 cases, 8/17 cases with relapse of thrombosis in different degree after 7 days kept for good state via the continued anticoagulation. There were only 2 cases with the ICP above 280 mmHg. No obvious relapse in 15/17 cases were found follow-up 3-60 months. Conclusion: The primary results of our group demonstrated that the successive thrombolysis and stent angioplasty for occlusion and thrombosis of venous sinuses are the effective and safe therapies which directly promoting drainage for cerebral venous blood and rapidly decreasing the ICP.
【Key words】Cerebral venous sinus Thrombosis Occlusive Thrombolysis Stent, 百拇医药(李宝民 郭梅 李生 王茂强)