支架成形术与抗凝治疗脑静脉窦狭窄的 疗效评估及预后分析

Comparison of clinical effect and prognosis of patients with cerebral venous sinus stenosis between stent angioplasty and anticoagulant therapy

摘要:

目的 分析脑静脉窦狭窄（CVSS）发病部位，比较支架形成术和抗凝2 种治疗方式的疗效及远 期预后。方法 选取2010 年7 月—2014 年12 月新疆医科大学第二附属医院收治的CVSS 患者98 例，均予 以全脑数字减影血管造影检查（DSA），并根据结果采用支架形成术（支架组）或抗凝治疗（抗凝组）。分 析CVSS 患者发病部位，比较两组静脉窦内压力、脑循环时间及脑脊液压力等指标的差异。随访3 年，比 较两组头晕症状复发与再狭窄发生率的差异。应用多元Logistic 回归分析随访3 年再狭窄发生率危险因素。 结果 横窦与乙状窦交汇处78 例，上矢状窦中段9 例，乙状窦近心段2 例，直窦部2 例，合并静脉窦憩室6 例， 合并Labbe’s 静脉狭窄1 例。支架组静脉窦内压力、脑循环时间及腰穿脑脊液压力低于抗凝组（P <0.05）。 随访3 年，支架组头晕症状复发率、再狭窄发生率低于抗凝组（P <0.05）。支架形成术是再狭窄发生率的危 险因素（P <0.05）。结论 CVSS 发病部位以横窦与乙状窦交汇处最多见，应用支架成形术治疗可取得较好疗 效，且远期预后较好。

Abstract:

Objective To analyze the lesion sites of patients with cerebral venous sinus stenosis (CVSS), and to compare the therapeutic effects and the long-term prognosis between stent angioplasty and anticoagulant therapy. Methods A total of 98 patients with CVSS in our hospital from July 2010 to December 2014 were collected for retrospective study. All patients were received the whole brain digital subtraction angiography (DSA) examination, and were chosen to undergo the stent angioplasty (stent group, 63 cases) or anticoagulant therapy (anticoagulant group, 35 cases) according to the results of DSA. The lesion sites of patients with CVSS were analyzed. The indexes of venous sinus pressure, cerebral circulation time and cerebrospinal fluid pressure were compared between two groups. Following up for 3 years, the incidence of dizziness and the recurrence of restenosis were compared between two groups. The risk factors of the restenosis in the three-year follow-up were analyzed by multivariate Logistic regression analysis. Results In 98 patients with CVSS, the lesion sites of the sigmoid sinus junction were 78 cases, and the lesion sites of the middle sagittal sinus were 9 cases, and the lesion sites of sigmoid sinus central segment were 2 cases, and the lesion sites of straight sinus were 2 cases, and the lesion sites combined with sinus diverticulum were 6 cases, and the lesion sites combined with Labbe’s vein stenosis was 1 cases. The indexes of venous sinus pressure, cerebral circulation time and cerebrospinal fluid pressure in stent group were lower than those in anticoagulant group, which were (11.16±2.29) mmHg vs (18.41±2.89) mmHg, (10.46±3.43) s vs (17.87±3.11) s and (226.95±48.74) mmH2O vs (296.13±67.78) mmH2O (all P < 0.05). Following up for 3 years, the incidence of dizziness and the recurrence of restenosis in stent group were lower than those in anticoagulant group, which were 3.17% (2/63) vs 17.14% (6/35), 0.00% (0/63) vs 8.57% (3/35) (all P < 0.05). The risk factor of the restenosis in the three-year follow-up was the stent angioplasty showed by multivariate Logistic regression analysis [Ol^R=3.218 (95% CI: 2.426, 4.102)]. Conclusions The most common lesion site of patients with CVSS is the sigmoid sinus junction. And the treatment of stent angioplasty can improve the therapeutic effects and the long-term prognosis of patients with CVSS.