Analysis Of The Effect Of Mechanical Thrombectomy Combined With Local Thrombolysis Versus Local Thrombolysis In The Treatment Of Severe Venous Sinus Thrombosis

Background and purposePatients with severe venous sinus thrombosis have severe clinical symptoms and usually include at least one baseline factor that increases the risk of poor prognosis,including mental state disorder,cerebral hemorrhage,coma,and deep venous system thrombosis.Previous studies have suggested that early endovascular treatment may be beneficial to these patients.Endovascular treatment of intracranial venous sinus thrombosis includes local thrombolysis,catheter thrombosis,stent thrombus removal,balloon dilation,etc.Different centers may use different methods of treatment.At present,there is no unified surgical procedure and different treatment methods.There is still a lack of clinical studies on the impact on the clinical outcome of patients with intracranial venous sinus thrombosis.There are two types of endovascular treatment options for severe CVST in our center,including local thrombolysis and combination therapy(mechanical thrombectomy combined with local thrombolysis).The purpose of this study is to retrospectively collect baseline data and postoperative data of the two treatment programs in our center to compare the efficacy of the two treatment programs.In addition,through retrospective analysis of the clinical and imaging data of patients with severe venous sinus thrombosis with poor prognosis after endovascular treatment,to explore the factors affecting the poor prognosis of patients with severe venous sinus thrombosis.Materials and MethodsA retrospective collection of patients diagnosed with intracranial venous sinus thrombosis in the First Affiliated Hospital of Zhengzhou University from January 2015 to October 2020.The target population was screened according to the definition of severe venous sinus thrombosis;according to different treatment methods,they were divided into local Thrombolysis group and mechanical thrombectomy combined with local thrombolysis group.Collect the patient’s general information,imaging data(using imaging methods to evaluate the recanalization of the venous sinus and brain parenchymal damage before and after treatment),laboratory examination results,and compare the venous sinus recanalization,mRS at discharge and mRS at follow-up between the two groups of patients after endovascular treatment,and compare the incidence of complications between the two groups.In addition,univariate and multivariate analyses were performed on the baseline data of patients with poor prognosis.ResultsA total of 402 patients with venous sinus thrombosis were enrolled,of which 180 patients met the diagnostic criteria for severe venous sinus thrombosis,of which 108 were in the local thrombolysis group,with an average age of 32±5(14-68)years,male to female ratio=1:1.3;combined treatment group 72 cases,with an average age of 31±4.7(13-66)years old,male to female ratio=1:1.25.The recanalization rate of venous sinus in the conjoint treatment group was higher than that in the local thrombolysis group(97.3%vs 88.0%,P=0.032).In the combined treatment group,57 cases(79.2%)had an mRS score of 0-2 at discharge,8 cases(11.1%)had an mRS score of 3-4,and 7 cases(9.7%)had an mRS score of 5-6.The suppository group was 76.8%,16.6%,and 6.5%,respectively,and there was no statistical difference between the two groups(P=0.825).At the 6-month follow-up,63 cases(92.6%)with mRS scores of 0-2 in the combined treatment group,3 cases(4.4%)with mRS scores of 3-4 and 2 cases(2.9%)with mRS scores of 5-6,While the local thrombolysis group was 91.3%,7.5%,1.3%,there was no statistical difference between the two groups(P=0.785).A total of 13 patients in this study had a poor prognosis.Univariate analysis showed that disturbance of consciousness(P=0.000),intracranial hemorrhage(P=0.000)and postoperative sinus recanalization(P=0.000)were related to the poor prognosis.Analysis showed that disturbance of consciousness(P=0.017)and intracranial hemorrhage(P=0.002)increased the risk of poor prognosis.Conclusions1.Through the comparative analysis of the curative effect of the two treatment programs of our center,we believe that for patients with severe venous sinus thrombosis,mechanical thrombus removal combined with local thrombolytic therapy can increase the recanalization rate of venous sinus,but does not affect the patient’s functional prognosis.2.Consciousness and intracranial hemorrhage may increase the risk of poor prognosis in patients with severe CVST endovascular treatment.