Li Xudong, Li Tie, Fan Yimu
Department of Neurosurgery, Tianjin Huanhu Hospital Tianjin, China.
Department of Encephalopathy, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine Tianjin, China.
Am J Transl Res. 2021 Jun 15;13(6):6921-6928. eCollection 2021.
To evaluate the efficacy of Solitaire AB stent mechanical thrombectomy combined with thrombolysis and anticoagulant therapy (AT) in the treatment of cerebral venous sinus thrombosis (CVST) and its effect on neurological function and coagulation indices.
Eighty-two patients with CVST were randomly divided into two groups according to the random number table method. The control group (n=41) were treated with arteriovenous thrombolysis combined with AT, and the observation group were treated with intravascular mechanical thrombectomy plus thrombolysis combined with AT. The effect of the treatment was evaluated 7 days after treatment, and a 6-month follow-up was conductedz after the course of treatment. The clinical efficacy, neurological function (National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS)), coagulation function, complications and prognosis were compared between the two groups.
The continuous improvement rate of clinical symptoms 7 days after treatment in the observation group (87.80%) was higher than that in the control group (58.54%) (P<0.01); The neurological function scores of both groups after treatment were lower than those before treatment (all P<0.001); The scores of NIHSS and mRS in the observation group were lower than those in the control group 7 days after treatment (all P<0.001). The coagulation indices of fibrinogen (FIB), prothrombin time (PT) and activated partial thromboplastin time (APTT) of 7 days after treatment in the observation group were shorter than those in the control group (all P<0.001), and the D-Dimer (D-D) level in the observation group was higher than that in the control group (P<0.001). The incidences of intracranial hemorrhage, infection, headache, quadriplegia, dizziness and drowsiness in the observation group were lower than those in the control group (all P<0.05). The recanalization rate of venous sinus in the observation group was higher than that in the control group 6 months after treatment (P<0.01).
Intravascular mechanical thrombectomy plus thrombolysis combined with AT for patients with CVST is effective, which can effectively improve the coagulation function and promote the recovery of neurological function, with fewer complications and a good prognosis.
评估Solitaire AB支架机械取栓联合溶栓及抗凝治疗（AT）在治疗脑静脉窦血栓形成（CVST）中的疗效及其对神经功能和凝血指标的影响。
将82例CVST患者按随机数字表法随机分为两组。对照组（n = 41）采用动静脉溶栓联合AT治疗，观察组采用血管内机械取栓加溶栓联合AT治疗。治疗7天后评估治疗效果，并在疗程结束后进行6个月随访。比较两组的临床疗效、神经功能（美国国立卫生研究院卒中量表（NIHSS）、改良Rankin量表（mRS））、凝血功能、并发症及预后。
观察组治疗7天后临床症状持续改善率（87.80%）高于对照组（58.54%）（P < 0.01）；两组治疗后的神经功能评分均低于治疗前（均P < 0.001）；治疗7天后观察组的NIHSS和mRS评分低于对照组（均P < 0.001）。观察组治疗7天后纤维蛋白原（FIB）、凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）的凝血指标短于对照组（均P < 0.001），观察组的D - 二聚体（D - D）水平高于对照组（P < 0.001）。观察组颅内出血、感染、头痛、四肢瘫痪、头晕和嗜睡的发生率低于对照组（均P < 0.05）。治疗6个月后观察组静脉窦再通率高于对照组（P < 0.01）。
血管内机械取栓加溶栓联合AT治疗CVST患者有效，可有效改善凝血功能，促进神经功能恢复，并发症少，预后良好。
