Analysis On The Outcome Of Anticoagulant Therapy And Combined With Endovascular Treatment In Patients With Severe Cerebral Venous Sinus Thrombosis

Part Ⅰ.Clinical features and outcome of cerebral venous sinus thrombosisObjectives:Cerebral venous sinus thrombosis(Cerebral Venous Sinus Thrombosis,CVST)is a rare disease.the purpose of this study was to make a retrospective analysis of the clinical data of CVST patients in the first people’s hospital of kunming in the past 7 years,to summarize the clinical characteristics of CVST patients and to strengthen the clinical understanding of the patients,by analyzing the different pathogenic factors and the treatment results of CVST patients,to provide theoretical basis for clinical diagnosis and treatment in the future.Methods:Retrospective analysis of clinical data characteristics of 62 patients between January 2013 and June 2019.Mainly include sex,age,onset to visit time,clinical manifestations at the time of onset,admission imaging examination results and treatment methods after admission,after admission GCS score,modified Rankin score(Modified Rankin Scale,mRS)and other relevant clinical data at discharge.summarized the characteristics of general clinical data and statistically analyzed the correlation between each factor and the mRS score at discharge.Results:There was no difference between sex and age group and CVST outcome,and there was no significant difference(P>0.05).the prognosis of patients with admission performance consciousness disorder was worse in clinical manifestations,and the difference was statistically significant(P<0.05).there was no difference between the occurrence of the remaining clinical manifestations and the outcome of the patients,and the difference was not statistically significant(P>0.05).There was no difference between CVST stage and short-term outcome,and the difference was not statistically significant(P>0.05).The prognosis of patients with the involvement of the straight sinus was worse,the difference was statistically significant(P<0.05),the position of the remaining involved and the rest of the venous sinus was not significantly different from the outcome of the patients,and the difference was not statistically significant(P>0.05).Different treatment methods and outcomes were not significantly different,the difference was not statistically significant(P>0.05).The prognosis of patients with admission GCS score<9 was worse,and the difference was statistically significant(P<0.05).Multivariate logistics regression analysis showed that patients with disturbance of consciousness and GCS score<9 had worse prognosis,and the difference was statistically significant(P<0.05).Conclusions:to the confirmed CVST patients timely anticoagulant treatment,the vast majority of patients with good prognosis;if patients with disturbance of consciousness,involving the straight sinus,GCS score<9 should be anticoagulant treatment as early as possible,can improve the prognosis.GCS<9 points,is an independent risk factor for CVST patients with poor prognosis.Part Ⅱ:Analysis on the outcome of anticoagulant therapy and combined with endovascular treatment in patients with severe cerebral venous sinus thrombosisObjectives:Some patients with severe CVST have poor anticoagulant effect,the Endovascular treatment(Endovascular Treatment,EVT)is the final choice for sthem.which aims to analyze the difference of short-term prognosis between simple anticoagulant therapy and combined EVT in patients with severe CVST through clinical study of severe patients in the first people’s hospital of Kunming in the past 7 years.Methods:Retrospective analysis of 39 patients with severe CVST from January 2013 to June 2019 was conducted,It mainly includes sex,age,time of onset,clinical manifestation of onset,admission imaging findings and treatment after admission,and admission GCS scores,clinical data such as discharge time,discharge March,discharge June mRS score and so on.statistical analysis of the difference of short-term prognosis between simple anticoagulant therapy and combined EVT in patients with severe CYST.Results:The GCS score of single anticoagulant group and anticoagulant combined EVT group was higher than that of admission GCS,and the difference was statistically significant(P=0.001,P<0.001).The rate of complete recanalization of blood vessels after one month in anticoagulant combined with endovascular therapy group was better than that in anticoagulant group(P=0.038<0.05),and there was no significant difference in mortality rate,postoperative and bleeding rate(P<0.05).The prognosis of patients with anticoagulant combined with EVT was better than that of patients with simple anticoagulant,and the difference was statistically significant(P<0.05).The scores of anticoagulant combined EVT patients were lower than those of simple anticoagulant patients when discharged,discharged for 3 months,and discharged for June mRS,and the difference was statistically significant(P<0.05).Conclusions:.Anticoagulant therapy and combined EVT can significantly improve the GCS score of patients with severe CVST.EVT combined with systemic anticoagulation can obviously improve the short-term prognosis of patients with severe CVST.