摘要： 研究背景 通过综合分析颈静脉孔区颅内静脉窦血管造影术影像学表现，探讨颅内静脉窦支架植入困难或失败原因，并寻找可预测静脉窦狭窄支架植入困难的临床指标，以提高手术成功率。方法 对118 例接受颅内静脉窦支架植入术患者（窦狭窄伴颅内高压87例、窦狭窄致搏动性耳鸣31例）的临床资料进行回顾，分析颈静脉孔区静脉窦两个转折夹角及静脉窦直径对支架植入技术成功的影响。结果 共115 例患者术中支架植入成功、3 例因支架植入困难而导致手术失败。颈静脉孔区静脉窦为连接乙状窦和颈内静脉的过渡结构，侧位脑血管造影呈典型"N"形结构，支架植入成功者静脉窦两个转折夹角之和为（120.11 ± 30.32）° 、失败者为（86.37 ± 10.72）° ，二者差异有统计学意义（t = 23.420 ，P = 0.001）；静脉窦直径分别为（5.10 ± 1.12 ）和（5.11 ± 0.37 ）mm，差异无统计学意义（t = 7.210，P = 0.352）。结论 颈静脉孔区静脉窦侧位脑血管造影呈"N"形结构，若静脉窦两转折夹角过小易导致支架植入困难，但静脉窦直径不影响支架的植入。

关键词:  颈静脉, 脑血管造影术, 血管成形术, 支架, 窦血栓形成, 颅内

Abstract: Background  By analyzing the digital subtraction angiography (DSA) of intracranial venous sinus in jugular foramen segment, this article investigates the reasons for difficulty or failure of stent implanting in intracranial venous sinus, and attempts to formulate the clinical index, which can predict the difficulty of venous sinus stenting so as to improve the success rate of stent implantation. Methods  All of 118 patients treated with venous sinus stent angioplasty were analyzed retrospectively, among whom 87 cases were diagnosed as cerebral venous stenosis and intracranial hypertension, and 31 patients were diagnosed as intractable pulsatile tinnitus caused by venous sinus stenosis. All patients received thrombolysis, anticoagulant and antiplatelet agents, and stent was implanted since the symptoms were not relieved. The two turning angles and diameter of cerebral venous sinus in the jugular foramen were measured to analyze their impact on stent implantation. Results  Stent implantation of 115 cases were successful, while 3 patients did not complete the surgery due to the difficulty of stent implanting. The cerebral venous sinus in the jugular foramen was a transitional structure between the sigmoid sinus and internal jugular vein. Lateral view of angiography suggested "N" shape. The sum of two turning angles of venous sinus of 115 patients was (120.11± 30.32)°, and the diameter of venous sinus was (5.10 ± 1.12)mm. The sum of two turning angles of 3 patients who failed to implant stent was (86.37 ± 10.72)°, and the diameter of venous sinus was (5.11 ± 0.37) mm. There were statistically significant differences between the angles of two groups (t = 23.420, P = 0.001), but no significant differences between the diameters of two groups ( t = 7.210, P = 0.352). Conclusion  Lateral view of angiography suggested "N" shape of venous sinus in the jugular foramen. Difficulty of stent embedding would be caused by too small turning angles of venous sinus in the jugular foramen. However, the diameter of venous sinus did not influence the sugery ofstent implantation.

Key words: Jugular veins, Cerebral angiography, Angioplasty, Stents, Sinus thrombosis, intracranial