Konakondla Sanjay, Schirmer Clemens M, Li Fengwu, Geng Xiaogun, Ding Yuchuan
1 Department of Neurosurgery, Geisinger Health System, Danville, PA 17822, USA.
2 Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
Aging Dis. 2017 Apr 1;8(2):136-148. doi: 10.14336/AD.2016.0915. eCollection 2017 Apr.
Dural venous sinus thrombosis (DVST) is a rare cause of stroke, which typically affects young women. The importance of identifying pre-disposing factors that lead to venous stasis lies in the foundation of understanding the etiology, pathophysiology and clinical presentation. The precise therapeutic role of interventional therapies is not fully understood though the current data do suggest potential applications. The aim of the study was to perform a systematic review and meta-analysis to evaluate the utility of and short-term 30-day survival after endovascular therapy for patients with DVST. Standard PRISMA guidelines were followed. Data sources included PubMed keywords and phrases, which were also incorporated into a MeSH search to yield articles indexed in Medline over a 5-year period. All RCTs, observational cohort studies, and administrative registries comparing or reporting DVST were included. Sixty-six studies met inclusion criteria. 35 articles investigating treatment in a summation of 10,285 patients were eligible for data extraction and included in the review of treatment modalities. A total of 312 patients were included for statistical analysis. All patients included received endovascular intervention with direct thrombolysis, mechanical thrombectomy or both. 133 (42.6%) patients were documented to have a neurologic decline, which prompted endovascular intervention. All patients who had endovascular interventions were those who were started on and failed systemic anticoagulation. 44 patients were reported to have intracranial hemorrhages after intervention. Regardless of systemic anticoagulation, patients were still reported to have complications of VTE and PE. Primary outcome at 3-6 month follow up revealed mRS<1 in 224 patients. DVST presents with many diagnostic and therapeutic challenges. The utility of invasive interventions such as local thrombolysis and mechanical thrombectomy is not fully understood. It is exceedingly difficult to conduct large randomized trials for this low incidence disease process with large pathophysiological heterogeneity.
硬脑膜静脉窦血栓形成（DVST）是一种罕见的中风病因，通常影响年轻女性。识别导致静脉淤滞的易感因素的重要性在于理解病因、病理生理学和临床表现的基础。尽管目前的数据确实表明了介入治疗的潜在应用，但介入治疗的确切治疗作用尚未完全明确。本研究的目的是进行系统评价和荟萃分析，以评估血管内治疗对DVST患者的效用和30天短期生存率。遵循标准的PRISMA指南。数据来源包括PubMed关键词和短语，这些也被纳入医学主题词（MeSH）搜索，以获取5年内Medline索引的文章。所有比较或报告DVST的随机对照试验（RCT）、观察性队列研究和行政登记都被纳入。66项研究符合纳入标准。35篇调查治疗方法的文章，共涉及10285例患者，符合数据提取条件并纳入治疗方式的综述。共有312例患者纳入统计分析。所有纳入的患者均接受了直接溶栓、机械取栓或两者兼有的血管内介入治疗。133例（42.6%）患者有神经功能下降记录，这促使进行血管内介入治疗。所有接受血管内介入治疗的患者均为开始全身抗凝治疗但失败的患者。据报道，44例患者介入治疗后发生颅内出血。无论是否进行全身抗凝治疗，仍有患者发生静脉血栓栓塞症（VTE）和肺栓塞（PE）并发症。3 - 6个月随访的主要结局显示，224例患者改良Rankin量表（mRS）评分<1。DVST存在许多诊断和治疗挑战。局部溶栓和机械取栓等侵入性干预的效用尚未完全明确。对于这种发病率低且病理生理异质性大的疾病过程，进行大型随机试验极其困难。
