Department of Diagnostic Imaging, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, Colombia; Radiology Resident of Department of Diagnostic Imaging, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, Colombia.
Department of Clinical Neurology, Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, Colombia; Research Group NeuroUnal, Department of Clinical Neurology, Universidad Nacional de Colombia, Bogotá, Colombia; Clinical Neurology Resident, Department Clinical Neurology of Universidad Nacional de Colombia, Hospital Universitario Nacional de Colombia, Bogotá, D.C. Colombia.
J Vasc Interv Radiol. 2022 Oct;33(10):1173-1183.e1. doi: 10.1016/j.jvir.2022.06.026. Epub 2022 Jul 11.
Cerebral venous sinus thrombosis (CVST) is a rare but life-threatening condition. Mechanical thrombectomy is a treatment option for patients who deteriorate or do not improve despite anticoagulation treatment or those who have a major contraindication to anticoagulation. The purpose of this study was to describe the authors' 5 years of experience in treating CVST with vacuum aspiration thrombectomy without thrombolysis.
For this retrospective study, data were collected from consecutive patients with CVST who received anticoagulation as initial medical treatment and were treated with vacuum aspiration thrombectomy without thrombolysis. Patients were followed up at 3 months and after 1 year.
The 9 patients included in the study had a median age of 37 years, and 5 were women. All 9 patients had headaches at presentation; 7 had focal neurologic deficits, and 7 had intracranial hypertension. Risk factors for CVST were identified in 8 patients, and poor prognostic factors were identified in 7 patients. In the 9 patients, 24 CVST locations were treated; complete (70.8%) or partial (29.2%) recanalization was achieved in all CVST locations. No procedure-related complications occurred. One patient died of parenchymal hemorrhagic transformation of CVST and vasogenic edema, 6 hours after the procedure. Two patients required neurosurgical intervention. After 1 year (range, 13-30 months), all 8 surviving patients had good functional outcomes (modified Rankin Scale score 0-2).
For appropriately selected patients with CVST, vacuum aspiration thrombectomy without thrombolysis seemed to be an effective therapy.
脑静脉窦血栓形成（CVST）是一种罕见但危及生命的疾病。对于尽管接受抗凝治疗仍恶化或无改善的患者，或存在抗凝治疗重大禁忌的患者，机械血栓切除术是一种治疗选择。本研究的目的是描述作者在没有溶栓的情况下使用真空抽吸血栓切除术治疗 CVST 的 5 年经验。
在这项回顾性研究中，从接受抗凝治疗作为初始药物治疗且接受真空抽吸血栓切除术而未接受溶栓治疗的连续 CVST 患者中收集数据。患者在 3 个月和 1 年后进行随访。
研究纳入的 9 例患者的中位年龄为 37 岁，5 例为女性。所有 9 例患者在就诊时均有头痛；7 例有局灶性神经功能缺损，7 例有颅内压升高。8 例患者发现 CVST 的危险因素，7 例患者发现不良预后因素。在 9 例患者中，共治疗了 24 个 CVST 部位；所有 CVST 部位均实现完全（70.8%）或部分（29.2%）再通。无手术相关并发症发生。1 例患者在术后 6 小时因 CVST 实质出血性转化和血管源性水肿死亡。2 例患者需要神经外科干预。1 年后（范围为 13-30 个月），所有 8 例存活患者的功能结局良好（改良 Rankin 量表评分为 0-2）。
对于适当选择的 CVST 患者，在没有溶栓的情况下使用真空抽吸血栓切除术似乎是一种有效的治疗方法。
