摘要：

目的 探讨脑静脉窦内支架植入术中于球囊扩张状态下行脑血管造影术以预测术后穿支静脉回流情况的临床价值。 方法 共93 例脑静脉窦内支架植入术患者（包括51 例脑静脉窦狭窄合并颅内高压和42 例源于脑静脉窦狭窄的搏动性耳鸣），63 例直接行脑血管造影术测量横窦和乙状窦直径并根据测量结果选择支架，30 例于球囊扩张状态下行狭窄侧颈动脉或椎动脉造影术以明确穿支静脉回流情况，回流缓慢者选择较脑静脉窦直径小1 ~ 2 mm 的支架。 结果 脑静脉窦内支架植入术成功率达100%（93/93）。63 例根据脑血管造影术测量的横窦和乙状窦直径而选择支架患者中45 例选择9 mm ×40 mm 支架、15 例选择8 mm × 40 mm 支架、3 例选择7 mm × 40 mm 支架，支架平均直径（8.67 ± 0.68）mm；术后11 例（17.46%）出现穿支静脉回流缓慢。余30 例于球囊扩张状态下行颈动脉或椎动脉造影术而选择支架的患者中3 例选择8 mm × 40 mm 支架、11 例选择7 mm × 40 mm 支架、16 例选择6 mm × 40 mm 支架，支架平均直径（7.57 ± 0.67）mm；术后仅1 例（3.33%）出现穿支静脉回流缓慢。两组患者选择的支架直径（t = 15.632，P = 0.001）和术后穿支静脉闭塞发生率（校正χ² = 60.065，P = 0.001）差异均有统计学意义。 结论  脑静脉窦内支架植入术后穿支静脉闭塞是较为常见的并发症，术中于球囊扩张状态下行脑血管造影术可以有效预测穿支静脉闭塞的可能性，并为选择适宜直径的支架提供依据。

关键词: 脑血管障碍,  脑静脉, 缩窄, 病理性, 血管成形术, 支架,  脑血管造影术

Abstract:

Objective  To explore the clinical significance of balloon dilatation angiography during cerebral venous sinus stenosis stenting to predict the reflux of perforator veins after operation. Methods  A total of 93 patients (including 51 with cerebral venous sinus stenosis and intracranial hypertension and 42 with intractable pulsatile tinnitus caused by cerebral venous sinus stenosis) who were treated by stent implantation were analyzed retrospectively. Among those patients, the diameter of transverse and sigmoid sinuses of 63 cases were measured based on angiography, and stent was selected according to the measurement result. The other 30 cases were given angiography on ipsilateral carotid artery or vertebral artery when the balloon was dilated in the venous sinus to confirm the reflux of perforator veins. If the venous reflux decreased in the angiography, stent with diameter 1-2 mm less than that of venous sinus could be selected.  Results  The success rate of stenting was 100% (93/93). In 63 cases, 45 cases were planted 9 mm × 40 mm stents, 15 were planted 8 mm × 40 mm stents, 3 were planted 7 mm × 40 mm stents. The average diameter of stents was (8.67 ± 0.68) mm. There were 11 cases (17.46%) with slow perforator venous reflux after operation. In the other 30 cases, 3 cases were planted 8 mm × 40 mm stents, 11 were planted 7 mm × 40 mm stents, and 16 were planted 6 mm × 40 mm stents. The average diameter of stents was (7.57 ± 0.67) mm. There was only one case (3.33%) with slow perforator venous reflux after operation. The difference of stent diameter between 2 groups was statistically significant (t = 15.632, P = 0.001). The occurrence rate of perforator vein occlusion after operation between 2 groups was significantly different (adjusted χ ² = 60.065, P = 0.001).  Conclusions  Perforator vein occlusion after cerebral venous sinus stenting is common complication. Balloon dilatation angiography could predict the possibility of perforator vein occlusion effectively. This method could choose the stent with appropriate diameter.

Key words: Cerebrovascular disorders,  Cerebral veins, Constriction, pathologic, Angioplasty, Stents, Cerebral angiography