Department of Neurology, Medical College of Wisconsin and Froedtert Hospital, Milwaukee, Wisconsin, USA.
J Neurointerv Surg. 2012 Jan 1;4(1):22-6. doi: 10.1136/jnis.2010.004358. Epub 2011 Mar 1.
Limited data exist to guide patient selection for preventive treatment of unruptured cerebral aneurysms. Cerebral aneurysms have been associated with circle of Willis anomalies but whether this association is also related to aneurysm rupture is not known. The occurrence of cerebral aneurysm rupture when a circle of Willis anomaly was present or absent was compared.
Patients admitted over a 2 year period with a diagnosis of a cerebral aneurysm and an anterior communicating artery (ACoA) or posterior communicating artery (PCoA) aneurysm were included in the analysis. Brain vascular imaging was reviewed for aneurysm size, morphology and presence of circle of Willis anomaly. Relevant medical history and demographics were obtained from the medical records.
Of the 113 patients with ACoA or PCoA aneurysms, 85 (75.2%) cases were ruptured. There were 49 (43.4%) PCoA aneurysms and 64 (56.6%) ACoA aneurysms. Mean aneurysm size was 5.65 mm (SD 3.31). A circle of Willis anomaly was identified in 46 (40.7%) of all patients. Circle of Willis anomalies were present in 38 (46.9%) ruptured aneurysm cases and eight (29.6%) unruptured aneurysm cases. Multivariate analysis revealed a higher risk of aneurysm rupture when a circle of Willis anomaly was present (p=0.0245, OR 3.72 (CI 1.18 to 11.66)).
This series shows that circle of Willis anomalies are more commonly found in ruptured as opposed to unruptured cerebral aneurysms of the anterior and posterior communicating arteries. The presence of a circle of Willis anomaly may be an important characteristic for selecting patients for preventive aneurysm treatment.
目前用于指导未破裂脑动脉瘤预防性治疗患者选择的资料有限。脑动脉瘤与 Willis 环异常有关，但尚不清楚这种关联是否与动脉瘤破裂有关。比较 Willis 环异常存在和不存在时脑动脉瘤破裂的发生情况。
分析了在 2 年期间因诊断为脑动脉瘤和前交通动脉（ACoA）或后交通动脉（PCoA）动脉瘤而入院的患者。对脑血管成像进行了回顾，以评估动脉瘤的大小、形态和 Willis 环异常的存在。从病历中获得了相关的医疗史和人口统计学资料。
在 113 例 ACoA 或 PCoA 动脉瘤患者中，85 例（75.2%）为破裂性动脉瘤。其中 49 例为 PCoA 动脉瘤，64 例为 ACoA 动脉瘤。平均动脉瘤大小为 5.65mm（标准差 3.31）。所有患者中有 46 例（40.7%）存在 Willis 环异常。Willis 环异常在 38 例（46.9%）破裂性动脉瘤病例和 8 例（29.6%）未破裂性动脉瘤病例中存在。多变量分析显示，当存在 Willis 环异常时，动脉瘤破裂的风险更高（p=0.0245，OR 3.72（95%CI 1.18 至 11.66））。
本系列研究表明，Willis 环异常在破裂性和未破裂性前交通和后交通动脉脑动脉瘤中更为常见。Willis 环异常的存在可能是选择患者进行预防性动脉瘤治疗的一个重要特征。
