Clinical Analysis With Endovascular Mechanical Thrombectomy Versus Anticoagulation For Cerebral Venous Thrombosis

Background and objectiveCerebral venous sinus thrombosis(CVST)is a special type of cerebrovascular disease with a low incidence.This disease is easily missed or misdiagnosed by clinicians because of the complicated pathological and physiological changes,diverse risk factors and lack of specificity of clinical symptoms.With the development of imaging technology and the progress of endovascular intervention,the lethality and morbidity of CVST has decreased compared with the previous period.The etiology of CVST has not been determined.The existing clinical diagnosis and treatment methods and review methods still lacks a uniform standard.Anticoagulant therapy is currently the first-line treatment for CVST in clinical practice.However,this method can not immediately open obstructed sinus.If the treatment is delayed,the patient may have hernia or even death.Endovascular mechanical thrombectomy treatment can immediately open the obstruction of the sinus.Especially for patients with substantial brain injury,mechanical thrombectomy can prevent thrombolysis and avoid thrombolysis.The purpose of this study was to reduce the mortality and morbidity of CVST by comparing the safety and efficacy of the treatment for CVST and CVST with brain parenchymal injury.Matedals and methodsA retrospective study of 110 inpatients with CVST from January 2015 to December 2016 was taken in our hospital.33 patients were excluded and 77 patients were included(Male=31,Female=46,M:F=1:1.53).Subcutaneous injections of low-molecular-weight heparin(LMWM 2 times / d,180 units anti-activated factor X)were used to treat patients in the anticoagulant group and were treated with warfarin orally before discharge.Endovascular interventional surgery was used in the treatment of mechanical thrombectomy in patients with definite diagnosis.Patients underwent mechanical thrombectomy with mechanical balloon dilatation in combination with the Solitaire stent.After subcutaneous injection of LMWM(2 times / d)to patients,warfarin was given alternately to the patients after 3-7 days of maintenance.In this study,the basic data,clinical data,laboratory data,and imaging data of all enrolled patients were collected.The NIHSS score was used to assess the patient's neurological deficit and the Modified Rankin Scale was used to assess the patient's prognosis.Glasgow Coma Scale(GCS)was used to assess the recovery of disturbance of consciousness in those patients with brain parenchymal injury in both groups.To understand the nature of all patients with parenchymal lesions and venous sinus involvement confirmed by imaging diagnosis.All patients underwent examinations,the average follow-up was 6-24 months.Patients were followed up for 3 months,6 months and 12 months after discharge.ResultBasic characteritics such as age(P=0.726),ratio of sex(P=0.178),onset time(P =0.992)have no difference between groups.Of the 77 CVST patients,the subacute and chronic onset are the most common in the group of patients.61 patients have definite risk factors,and infectious risk factors are the most common of all risk factors,with two or more risk factors found in 10 patients.A variety of clinical symptoms were present in the patients,of which 63 were the most common clinical manifestations,and 32 patients showed varying degrees of symptoms and signs of increased intracranial pressure,5 patients with first symptom fever.Twenty-four patients in the endovascular mechanical thrombectomy group had cerebrospinal fluid pressure greater than normal.Twenty-one patients with systemic anticoagulant cerebrospinal fluid pressure than normal.In the endovascular mechanical thrombectomy group,serum D-dimer levels increased in 21 patients,with 18 patients in the systemic anticoagulation group increasing.One side of the transverse sinus and sigmoid sinus thrombosis is the most common sinus,involving 47 cases(61.0%)of patients.Multiple sinus venous involvement is most common in all cases,with a single sinus disease predominantly involving the superior sagittal sinus.Cerebral venous cerebral infarction occurred in 20 patients,with intravenous cerebral hemorrhage in 4 cases,complicated by venous cerebral infarction and cerebral hemorrhage in 10 cases.The neurological deficits in 27 cases were improved after treatment,8 cases had no obvious changes and 2 cases aggravated in the endovascular mechanical thrombectomy group.In the anticoagulant group,the neurological deficits in 18 patients were improved,20 cases had no obvious changes compared with the former and 2 cases were aggravated.The improvement of neurological deficit was better in mechanical thrombectomy group than in systemic anticoagulation group,the difference was statistically significant(P=0.040).Thirty patients recovered completely,two patients partially recovered,and six patients had residual disability in the mechanical thrombectomy group,while twenty-four patients recovered completely,11 partially recovered,4 disabled and 1 died in the anticoagulant group.There were similar clinical outcomes between the two groups,with no significant difference(P=0.065).The obstructed sinus had a complete recanalization in 7 patients and 15 had partial recanalization in endovascular mechanical thrombectomy group,when 11 patients have completely recanalized,5 patients have partial recanalization and 6 patients have failure result in anticoagulation group.Resuscitation sinus recanalization is better in mechanical thrombectomy,compared with simple anticoagulation,the difference was statistically significant(P=0.002).GCS scores of mechanical thrombectomy patients with brain parenchymal injury were 13 points(8-15 points)on average with 11 patients had better disturbance of consciousness after treatment.The GCS score of the systemic anticoagulation group was 14 points(11-15 points)on average with 3 cases of disturbance of consciousness improved.Consciousness recovery of patients with brain injury in mechanical thrombectomy CVST group was superior to systemic anticoagulation group,the difference was statistically significant(P=0.034).In the systemic anticoagulation group,1 patient was found to have cerebral infarction hemorrhage,mechanical thrombectomy group did not appear surgery related ICH and other complications.All patients were followed up for 6-24 months.No recurrence of thrombus was found in the follow-up period of mechanical thrombectomy and thrombosis occurred in 1 patient in the systemic anticoagulation group.ConclusionEndovascular mechanical thrombectomy treatment is a safe and effective treatment for cerebral venous sinus thrombosis.Compared with systemic anticoagulant therapy regimen,it is beneficial for the recovery of neurological deficits,the recanalization of obstructed venous sinuses.And endovascular mechanical thrombectomy treatment is beneficial for the recovery of consciousness disorder in CVST patients with brain parenchymal injury.Patients may be benefit from early interventional endovascular therapy.