Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
J Neurointerv Surg. 2010 Jun;2(2):153-6. doi: 10.1136/jnis.2009.001651. Epub 2010 Mar 5.
Venous sinus thrombosis can be a fatal condition. When systemic anticoagulation therapy fails or is high risk, endovascular chemical thrombolysis or mechanical thrombectomy may be necessary. We report our experience using the Penumbra system (PS; Penumbra, Alameda, California, USA) in a series of four patients with venous sinus thrombosis.
Four patients were treated with mechanical thrombectomy using the PS for venous sinus thrombosis. Three of these patients also underwent balloon angioplasty following the PS device. Utility of this technique was evaluated by procedural success, improvement in neurological condition, avoidance of complications and follow-up imaging.
Technical success was achieved in all four patients with restoration of flow in the occluded sinuses without the use of chemical thrombolysis. No complications were encountered during the procedure and no postprocedural complications were attributable to the thrombectomy. One patient with glioblastoma died 6 weeks after the procedure. No new intracerebral hemorrhages were caused and there was no exacerbation of pretreatment intracerebral hemorrhages. Follow-up imaging was available in all but one patient to documented continued sinus patency. Neurologic improvement was seen in all patients after thrombectomy. Two patients have returned for outpatient follow-up and both are doing well.
Endovascular treatment for venous sinus thrombosis with the PS is a safe and efficacious alternative to the other forms of mechanical thrombectomy reported in the literature. Good clinical and radiographic results can be obtained without the need for chemical thrombolysis.
静脉窦血栓形成可能是一种致命的疾病。当全身抗凝治疗失败或风险较高时，可能需要血管内化学溶栓或机械血栓切除术。我们报告了使用 Penumbra 系统（PS；Penumbra，加利福尼亚州阿拉米达，美国）治疗 4 例静脉窦血栓形成患者的经验。
4 例患者因静脉窦血栓形成接受 PS 机械血栓切除术治疗。其中 3 例患者在 PS 装置后还进行了球囊血管成形术。通过程序成功率、神经状况改善、避免并发症和随访成像来评估该技术的实用性。
所有 4 例患者均成功实现技术成功，闭塞窦内血流恢复，无需使用化学溶栓。手术过程中未发生并发症，且无术后并发症可归因于血栓切除术。1 例胶质母细胞瘤患者在手术后 6 周死亡。未引起新的颅内出血，也未加重治疗前的颅内出血。除 1 例患者外，所有患者均有随访成像，记录窦道持续通畅。血栓切除术后所有患者的神经功能均得到改善。2 例患者已返回门诊随访，情况良好。
与文献中报道的其他机械血栓切除术形式相比，使用 PS 治疗静脉窦血栓形成是一种安全有效的替代方法。无需化学溶栓即可获得良好的临床和影像学结果。
