Mechanical Thrombectomy With Solitaire AB Stent In The Treatment Of Cerebral Venous Sinus Throm Bosis: A Clinical Study

Research background:Cerebral venous sinus thrombosis(CVST)is a rare cerebral venous system disease,the incidence of various causes,clinical symptoms are complex,the lack of significant specificity and common clinical manifestations are symptoms of headache,epilepsy and focal neurological deficits,serious can appear in a coma.Due to the different pathogenesis and clinical symptoms,the rate of missed diagnosis and misdiagnosis is high,and the delay of the diagnosis and treatment of the disease seriously affects the life and health of the patients.CVST is still one of the refractory cerebrovascular diseases.The main treatment methods are drug trerapy,intravascular interventional therapy and craniotomy.Although anticoagulant therapy is the preferred treatment for CVST,it is not effective for all patients.With the rapid development of neural interventional techniques and medical materials,new hope has been brought to the treatment of CVST.The purpose of this study is to clarify the characteristics of CVST and to further explore the clinical efficacy and prognosis of Solitaire AB stent thrombectomy for CVST.Part I:Clinical characteristics of cerebral venous sinus thrombosis and curative effect analysis of several treatmentsObjective:To investigate the clinical features,imaging changes,treatment and prognosis of patients with Cerebral Venous Sinus Thrombosis(CVST).Methods:Retrospective analysis of the clinical data of 90 patients with CVST,according to patients’ age,causes,clinical manifestations,imaging changes,treatment and curative effects of comprehensive analysis.Results:Among the 90 patients,41 were male and 49 were female.Average age:36.20±16.25;There were 7 cases associated with infection,27 cases of abnormal blood components,16 cases of pregnancy and puerperium,and 6 cases of oral contraceptives.Headache is the most common clinical manifestations,followed by epilepsy,consciousness disorder,and clinical symptoms are not single;The above sagittal sinus and transverse sinus were common.All the patients in the anti-infection treatment group improved,and the curative effect was 4 cases(57.14%).In the pure anticoagulation group,the efficacy was significantly 43 cases(70.49%),1 patient died and 2 cases were not improved.Three cases(75.00%)were effective in the stent thrombectomy group.There were 15 patients(83.33%)symptoms were obviously improved,the efficacy was significantly and 1 case of death in the stent thrombectomy and local thrombolysis group.Conclusion:The causes of CVST are diverse,the clinical symptoms are complex and changeable,and lack of specificity,to have a headache symptom onset.DSA is the gold standard for the diagnosis of CVST.Early diagnosis,timely and effective treatment can achieve good curative effect.Part Ⅱ:Mechanical thrombectomy with Solitaire AB stent combined with local thrombolytic therapy for cerebral venous sinus thrombosis and cerebral hemorrhage:the curative effect and prognosisObjective:To investigate the clinical efficacy and prognosis of Solitaire AB stent combined with local thrombolysis in the treatment of cerebral hemorrhage with cerebral venous sinus thrombosis.Methods:Retrospective analysis 29 cases of patients with cerebral hemorrhage with CVST,the interventional treatment(anticoagulant+Solitaire AB stent + local thrombolysis)14 cases,pure anticoagulant therapy 15 cases,comparing the clinical curative effect and prognosis of two groups of patients;Further analysis of the prognostic factors.Results:The effective rate,complete revascularization rate,and good prognosis of the interventional group(71.43%、71.43%、64.29%)were better than those of the anticoagulant therapy group(20.00%、13.33%、26.67%),and there were differences(P =0.021,P =0.004,P =0.048).The related factors leading to poor prognosis included straight sinus thrombosis,thrombus accumulative three sites and above,severe coma,bleeding volume of more than 30ml,and midline deviation greater than 10mm;Multivariate logistic regression analysis found that severe coma at admission(P = 0.011)was an independent risk factor for poor prognosis.Conclusion:Solitaire AB stent combined with local thrombolysis in the treatment of cerebral hemorrhage with CVST could effectively relieve the clinical symptoms and improve the prognosis of patients;The prognosis of patients with CVST complicated with cerebral hemorrhage is related to many factors,but severe coma at the time of admission often indicates a poor prognosis.