Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Neurosurgery. 2012 Mar;70(3):693-9; discussion 699-701. doi: 10.1227/NEU.0b013e3182354d68.
The risk factors predictive of intracranial aneurysm rupture remain incompletely defined.
To examine the association between various nonmodifiable risk factors and aneurysm rupture in a large cohort of patients evaluated at a single institution.
A retrospective analysis of patients admitted to a cerebrovascular facility between January 2006 and 2010 with a primary diagnosis of cerebral aneurysm. Aneurysms were divided into 2 groups: unruptured or ruptured. The dome diameter, aspect ratio (AR), location, sidedness, neck morphology, and multiplicity were entered into a central database. A full model was constructed, and a systematic removal of the least significant variables was performed in a sequential fashion until only those variables reaching significance remained.
We identified 2347 patients harboring 5134 individual aneurysms, of which 34.90% were ruptured and 65.09% were unruptured. On admission, 25.89% of aneurysms with a dome diameter <10 mm and 58.33% of aneurysms with a dome >10 mm were ruptured (P < .001). Of aneurysms with an AR >1.6, 52.44% presented following a rupture (P < .001). The highest incidence of rupture (69.21%) was observed in aneurysms with an AR >1.6, dome diameter <10 mm, and a deviated neck. Deviated neck-type aneurysms had a significantly greater incidence of rupture than classical neck-type aneurysms (P < .001).
An AR >1.6, dome diameter >10 mm, a deviated neck, and right-sidedness are independently associated with aneurysm rupture.
颅内动脉瘤破裂的预测因素仍不完全明确。
在单家医疗机构评估的大病例队列中，研究各种不可改变的危险因素与动脉瘤破裂之间的关系。
回顾性分析 2006 年 1 月至 2010 年期间因脑动脉瘤的主要诊断而收治于脑血管病机构的患者。将动脉瘤分为未破裂或破裂两组。将瘤顶直径、形态比（AR）、位置、侧别、颈部形态和多发性等参数输入中央数据库。建立全模型，并以系统的方式逐步去除最不重要的变量，直到仅保留达到显著水平的变量。
共纳入 2347 例患者，共 5134 个动脉瘤，其中 34.90%为破裂性，65.09%为未破裂性。入院时，瘤顶直径<10mm 的动脉瘤中 25.89%破裂，瘤顶直径>10mm 的动脉瘤中 58.33%破裂（P<0.001）。AR>1.6 的动脉瘤中，52.44%为破裂性（P<0.001）。AR>1.6、瘤顶直径<10mm 且颈部偏斜的动脉瘤破裂发生率最高（69.21%）。偏斜型颈部动脉瘤的破裂发生率明显高于经典型颈部动脉瘤（P<0.001）。
AR>1.6、瘤顶直径>10mm、颈部偏斜和右侧是与动脉瘤破裂独立相关的因素。
