Tarulli E, Sneade M, Clarke A, Molyneux A J, Fox A J
From the Department of Medical Imaging (E.T., A.J.F.), University of Toronto, Ontario, Canada
Oxford Neurovascular and Neuroradiology Research Unit (M.S., A.C., A.J.M.), University of Oxford, Oxford, UK.
AJNR Am J Neuroradiol. 2014 Aug;35(8):1551-5. doi: 10.3174/ajnr.A3991. Epub 2014 Jun 19.
Anterior communicating artery aneurysms account for one-fourth of all intracranial aneurysms and frequently occur in the context of A1 vessel asymmetry. The purpose of this study was to correlate circle of Willis anatomic variation association to angiographic and clinical outcomes of anterior communicating aneurysm coiling.
The Cerecyte Coil Trial provides a subgroup of 124 cases with anterior communicating artery aneurysms after endovascular coiling. One hundred seventeen of 124 anterior communicating artery aneurysms had complete imaging and follow-up for clinical outcome analysis, stability of aneurysm coil packing, and follow-up imaging between 5 and 7 months after treatment. Clinical outcomes were assessed by the mRS at 6 months.
Anterior cerebral artery trunk-dominance was seen in 91 of 124 (73%) anterior communicating artery aneurysms and codominance in 33 of 124 (27%) anterior communicating artery aneurysms. There was no significant difference (P > .5) in treatment success at 5-7 months for anterior communicating artery aneurysms between the anterior cerebral artery trunk-dominant (49 of 86, 57%) and anterior cerebral artery trunk-codominant (19 of 31) groups. Angiographic follow-up demonstrates a statistically significant increase in neck remnants and progressive aneurysm sac filling with the A1 dominant configuration (n = 21, 24% at follow-up versus n = 11, 12% at immediate posttreatment, P = .035). There was no statistically significant difference in clinical outcomes between types of anterior cerebral artery trunk configuration (P > .5).
Anterior communicating artery aneurysms with anterior cerebral artery trunk-dominant circle of Willis configurations show less angiographic stability at follow-up than those with anterior cerebral artery trunk-codominance similar to other "termination" type aneurysms. This supports the hypothesis that anterior cerebral artery trunk-dominant flow contributes to aneurysm formation, growth, and instability after coiling treatment.
前交通动脉瘤占所有颅内动脉瘤的四分之一，且常发生于A1血管不对称的情况下。本研究的目的是将Willis环解剖变异关联与前交通动脉瘤栓塞的血管造影及临床结果相关联。
Cerecyte线圈试验提供了124例前交通动脉瘤血管内栓塞后的亚组病例。124例前交通动脉瘤中有117例有完整的影像学资料及随访，用于临床结果分析、动脉瘤线圈填塞的稳定性以及治疗后5至7个月的随访影像学检查。临床结果在6个月时通过改良Rankin量表（mRS）进行评估。
124例前交通动脉瘤中有91例（73%）表现为大脑前动脉主干优势，33例（27%）表现为共优势。大脑前动脉主干优势组（86例中的49例，57%）和大脑前动脉主干共优势组（31例中的19例）在前交通动脉瘤5至7个月的治疗成功率上无显著差异（P>.5）。血管造影随访显示，在A1优势型中，颈部残余有统计学意义的增加且动脉瘤囊逐渐充盈（随访时21例，24%；治疗后即刻11例，12%，P=.035）。大脑前动脉主干构型类型之间的临床结果无统计学显著差异（P>.5）。
与其他“终末”型动脉瘤类似，Willis环构型为大脑前动脉主干优势的前交通动脉瘤在随访时血管造影稳定性低于大脑前动脉主干共优势的动脉瘤。这支持了以下假说：大脑前动脉主干优势血流促成了动脉瘤的形成、生长以及栓塞治疗后的不稳定性。
