Experimental And Clinical Research Cerebral Venous Sinus Thrombosis Which Was Treated By Injecting Urokinase Via Carotid Artery

Cerebral venous thrombosis is a sort of obliterated cerebral vascular diseases. It is reported since early 19th century. Detection rate of cvt was improved in recent 20 years by angiography. CVT predominates in young and middle-aged adults. Symptoms of cvt greatly vary in humans ,some people have focal deficit,inpairment of vision,subarachnoid hemorrhage and dead, others have headache only. So CVT is often called the clinical chameleon of neurology. The thesis is a research of effects and theoretical basis of injecting urokinase via carotid artery.PART 1.Effects of injecting urokinase via carotid artery in treatment of cerebral venous thrombosis: an experiment with rabbit models.Objective: To study the local cerebral blood flow,imaging and histology of injection of urokinase via carotid artery in treatment of cerebral venous sinus thrombosis. so as to provide theoretical basis for the clinical application. Methods: Thirty-nine New Zealand white rabbits were made into models of cerebral venous sinus thrombosis with the superior sagittal sinus ligated by monopolar electrocoagulation, and then were randomly divided into three groups: control group (n = 15), anticoagulation group (n = 12), and thrombolysis group (n = 12). Laser Doppler scanning was used to determine the local cerebral blood flow. Far-infrared drying oven was used to determine the the brain water content. DSA was used to determine the cerebral circulation time. CD31 was counted to determine the All the remaining rabbits were killed within 24 hours after the end of experiment to determine microvascular density (MVD). Result: The local cerebral blood flow of the thrombolysis group was 94.8% +/- 0.3%, significantly higher than those of the anticoagulation group (88.6% +/- 0.3%) and control group (80.9% +/-0.3%) (both P < 0.01). The brain water content of the thrombolysis group was 78.9% +/- 0.3%, significantly lower than those of the anticoagulation group (81.8% +/- 0.7%) and control group (82.1% +/- 1.0%) (both P < 0.05). Cerebral circulation time of thrombolysis group was 4.8 +/- 0.5s significantly lower than those of anticoagulation group(6.8±0.5s) and control group(7.0±0.5s)(both P<0.05). Microvascular density of thrombolysis group were 4.55±0.20% significantly higher than those of anticoagulation group (3.55±0.23%) and control group (2.28±0.75%) (both P< 0.01 ) .Conclusion: Improving the local blood flow, microvascular density and reducing the brain water contend cerebral circulation time, injection of urokinase via carotid artery is effective in treatment of cerebral venous sinus thrombosis,although the superior sagittal sinus was obliterative. Thrombolysis of extension of thrombus from the SSS into cortical veins is important.PART2.Clinical research of cerebral venous sinus thrombosis which was treated by injecting urokinase via carotid artery. Objective: Injection urokinase via common carotid artery was taken to cure cerebral venous thrombosis. Collateral vein and clinical effects were determined by clinical research. Methods :A11 of 79 patients cerebral venous thrombosis which were treated in our department from 11/2001 through 12/2007 were analyzed retrospectively. Intracranial pressure of 79 patients are 340.9±88.5 mmH20. The DSA suggested cerebral circulation time of all patients were longer than 11 s,the longest one is 22s. The superior sagittal sinus was involved in 50 patients (63.3%) and the transverse sinus in 64 (81.0%).The sigmoid sinus was involved in 26 patients( 32.9% )and the straight sinus in 15 patients (19.0%) . The deep venous was involved in 6 patients (7.6%) . Sixhty-seven patients were treated with injection urokinase via common carotid artery. Twelve were treated by injection urokinase via common carotid artery after endovascular therapy via catheterization of venous sinus. Result: Intracranial pressure of 79 patients reduce down 249.7±79.2 mmH20, reangiography revealed recanalization partly in 23patients, collateral venous were determined in75 patients. Circulation time appeared near normal in 79 patients. Modified Rankin Scale score at discharge: 0 (57 patients), 1 (18patients), 2 (3patients),3 (1patient), 4 (none), 5 (none). Conclusion : Injecting urokinase via carotid artery is effective ,safety and easy to operate. thrombolysis via carotid is suitable for diffused CVT, deep venous and cortex venous thrombosis and chronic CVT. Thrombolysis via carotid speed up the formation of collateral circulation. Collateral venous include cotex vein and sylvian vein, vertebral venous plexus, scalp venous drainage.