A preliminary study on the efficacy of anticoagulants combined with endovascular treatment for subacute and chronic cerebral venous sinus thrombosis assisted by high resolution magnetic resonance black⁃blood thrombus imaging

Abstract

Objective To investigate the efficacy and safety of combined anticoagulants with endovascular treatment for subacute and chronic cerebral venous sinus thrombosis (CVST) under the assistance of high resolution magnetic resonance black⁃blood thrombus imaging (MRBTI). Methods and Results A retrospective study was performed on the patients with CVST who were treated at Department of Neurosurgery of Tianjin Huanhu Hospital from January 2019 to January 2021. Preoperative high resolution MRBTI confirmed 15 patients with subacute and chronic CVST, and endovascular treatment was performed on the basis of systemic anticoagulant therapy. The results showed that 10 cases were in subacute stage and 5 cases were in chronic stage. After treatment, the venous sinus was completely recanalized in 4 cases and partially recanalized in 11 cases. Complications occurred in 2 cases (intracranial hematoma enlarged in one case, microguide wire penetrated straight sinus wall during surgery in one case), contact thrombolytic therapy was continued after the condition stabilized. The mean indwelling time of microcatheter in straight sinus was (6.27 ± 0.21) d and the mean length of hospital stay was (11.53 ± 1.30) d. The degree of impairment of consciousness [Glasgow Coma Scale (GCS) score] was improved at discharge [at discharge (13.67 ± 2.02) score vs. at admission (11.67 ± 2.13) score; t = 9.165, P = 0.000], the degree of neurological impairment [modified Rankin Scale (mRS) score] was improved 6 months after surgery [at 6 months after surgery 1 (0, 2) score vs. at admission 3 (2, 4) score; Z = ⁃ 3.624, P = 0.000]. Conclusions High resolution MRBTI is an effective technique to identify subacute and chronic CVST patients. For these patients, the combination of systemic anticoagulation and endovascular treatment can reduce venous sinus thrombosis load and improve symptoms in a short time, which is a safe, effective and preferred treatment.

doi：10.3969/j.issn.1672⁃6731.2022.06.005