Individualized endovascular treatment of intracranial vein sinous thrombosis based on the stage of disease / 中华神经科杂志

ABSTRACT

Objective To discuss the individualizing schedule of endovascular treatment for intracranial venous sinus thrombosis based on the clinical feature and the stage of the disease.Methods Forty-three patients diagnosed with intracranial venous sinus thrombosis in Xuanwu Hospital,Capital University of Medical Sciences and in Zhongshan Hospital Xiamen University during period of August 2010 to August 2011 were treated with endovascular therapy designed individually based on the clinical stage of the disease development.Of all 43 cases,22 cases with acute onset (＜ 1 week after the onset) were treated with standard anticoagulant therapy ; 11 cases who failed to respond to anticoagulant therapy and 8 cases with subacute onset (1 week to 1 month) received intravenous thrombolysis and mechanical thrombus maceration;and 13 cases with chronic course (＞ 1 month) were given mechanical thrombus maceration combined with balloon dilation vascular surgery or stent-assisted venous sinus surgery,with taking anticoagulant for 12months.The patients were followed up for 3 to 6 months (mean 4.5 months).Results Their symptoms and signs were all significantly improved,with headache relief in 29 cases(67.4％),vision improvement in 28cases (28/31,90.3％),cerebrospinal fluidpressure decrease to normal level in 32 cases(32/43,74.4％) ;no improvement in 1 case,and a complication of subdural hematoma in 1 case.Three months follow-up of 39 patients,symptoms disappeared,the pressure cerebrospinal fluid in 36 cases returned to normal (94.3％),the papilledema in 37 cases subsided (94.9％).After 6 months,16 patients were followed up with an angiography; 8 of them were found venous sinus clear,5 were found partial recanalization of venous sinus trunk,cortical veins and deep venous was partially compensation,and 3 cases with stent-assisted venous sinus surgery were found the stent not shifted or collapsed,and venous sinuses maintained patency.Conclusions Endovascular treatment for patients with intracranial venous sinus thrombosis should be treated with individually designed therapy based on their clinical features and the stage of the disease.The individualized treatment was effective and safe.