Clinical Study Of Thrombolytic Therapy For Severe Cerebral Venous Sinus Thrombosis

Background:Cerebral venous sinus thrombosis(CVST)is a rare cerebral venous system stroke,accounting for about 0.5% to 1% of all strokes.The main pathophysiological mechanism of CVST was thrombosis of cerebral venous sinus,deep veins and cortical veins thrombosis by various causes,causing reflux obstruction of the intracranial venous system and increasing intravenous pressure.Moreover,as the venous pressure increase,the cerebrospinal fluid reflux disorder further to increase the intracranial pressure.Then,that would cause a series of clinical signs and symptoms,including headache,nausea and vomiting,blurred vision,pulsating tinnitus,limb paralysis,disturbance of consciousness,and even coma.Due to its diverse clinical manifestations and non-characteristics,the rate of missed diagnosis and misdiagnosis of venous sinus thrombosis is as high as 25-50%,some patients have reached the subacute or chronic phase at the time of diagnosis,and the clinical symptoms are heavy.The mortality rate is as high as 10%-30%.Anticoagulant therapy is the first line of treatment for CVST.However,the traditional anticoagulant therapy is mainly to prevent further thrombosis and pulmonary embolism.For patients with severe or long-term CVST,anticoagulant therapy is unable to make the sinus patency in time,which aggravates the patient's condition and the prognosis of patients often poor.There is currently no uniform treatment standard for severe CVST.Anticoagulant therapy can alleviate the symptoms of patients,however,there is no significant effect on the recanalization of the patient's sinus.In recent years,interventional thrombolysis plays an important role in the treatment of severe CVST,studies have shown that local interventional thrombolysis has a positive effect on CVST,especially for patients with severe CVST,which is more conducive to the prognosis of patients.The aim of this study was to explore the safety and efficacy of local interventional thrombolysis in the treatment of patients with severe CVST,and further to provide guidance and evidence for the future treatment of CVST.Methods:Retrospective analysis of 182 patients with CVST,and 156 patients were diagnosed severe CVST and underwent interventional thrombolysis and 116 patients participate in the follow-up among them from January 2010 to January 2018.On the basis of anticoagulant therapy,all patients underwent intracranial interventional thrombolysis.Digital Subtract Angiography(DSA)further confirmed the position of the thrombosis,and the duration of thrombolysis was 5-7 days.Low molecular weight heparin was subcutaneous injected for 3 days after micro-catheter extraction,and Warfarin was taken together.After that,stopping injecting low molecular weight heparin and continuing taking Warfarin,and monitoring coagulation with maintaining International Normalized Ratio(INR)at 2.0-3.0,or oral Ticagrelor.The clinical manifestations,risk factors,treatment process,sinus recanalization(imaging performance),patient prognosis outcome(modified Rankin scale),and complication rate were statistically analyzed and summarized.All patients were followed up for 6 months,and the venous sinus recanalization rate and mRS score were compared among admission,discharge and follow-up.Results:In this study,the ratio of male to female patients was 1:3,and the age range of 14-68 years old.The subacute onset was the common in all of the severe CVST patients on admission.Pregnancy and puerperium were the most common risk factors for female patients,and infection was the most common risk factor for male patients.Clinical manifestations of severe CVST are not characteristic.The most common clinical manifestations were headache with or without nausea and vomiting(86.21%),Imaging studies showed that 37.93% of patients involved a single venous sinus,and 62.07% of patients involved two or more sinuses,and the SSS and TS were most commonly involved among them.After interventional thrombolytic therapy,58.62% of patients were completely recanalized,33.62% of patients were partially recanalized,and 7.76% of patients had no venous sinus;74.14% of patients had complete recanalization during sinus discharge,and 19.83% of patients had partial venous sinus,6.03% of patients had no recanalization of sinus;78.84% of patients had a mRS score of 0-2,16.03% had a mRS score of 3-4,and 5.13% had a mRS score of 5-6.116 patients were followed up for a follow-up rate of 74.36%.76.73% of venous sinus was completely patency at follow-up,18.1% of venous sinus was unobstructed,and 5.17% of patients had venous sinus thrombosis.At follow-up,91.38% of patients had a mRS score of 0-2,6.90% had a mRS score of 3-4,and 1.72% died during follow-up(mRS 6).Conclusion:Interventional thrombolysis for CVST is safe and effective,and is more effective to sinus recanalization and prognosis in patients with severe CVST,Visual impairment,dyskinesia,and disturbance of consciousness can affect the prognosis of patients with severe CVST.