Gross Bradley A, Lai Pui Man Rosalind, Du Rose
Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston 02115, USA.
Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston 02115, USA.
Clin Neurol Neurosurg. 2014 Aug;123:78-82. doi: 10.1016/j.clineuro.2014.05.014. Epub 2014 May 29.
Recent studies have reinforced anterior communicating (AComm) artery location as a significant risk factor for aneurysm rupture in addition to posterior circulation/posterior communicating (PComm) artery location. However, studies stratifying aneurysm location in greater detail are sparse.
We reviewed the records of 747 consecutive patients with 1013 aneurysms seen at our institution over a 7 year period, noting aneurysm location and rupture status at the time of presentation.
High proportions of ruptured aneurysms were seen among frontopolar/pericallosal (59%, OR 3.07, p=0.011), vertebral/posteroinferior cerebellar (PICA; 53%, OR 2.49, p=0.0037), AComm (50%, OR 2.46, p<0.0001), and PComm aneurysms (44%, OR 1.77, p=0.0016). Low proportions of ruptured aneurysms were seen among superior hypophyseal artery (SHA; 6%, OR 0.12, p=0.0001), internal carotid artery (ICA) bifurcation (12%, OR 0.27, p=0.0012), and ophthalmic artery aneurysms (15%, OR 0.33, p=0.0002). The proportion of ruptured PComm aneurysms demonstrated a trend toward being greater than anterior choroidal artery aneurysms (OR 2.14, p=0.09); however the proportion was significantly greater among anterior choroidal artery aneurysms as compared to nonPComm intradural ICA aneurysms (OR 2.78, p=0.03). Notably, the lower rupture rate of SHA aneurysms as compared to ophthalmic artery aneurysms neared statistical significance (OR 0.38, p=0.10).
Aneurysm location has a significant impact on risk of rupture and should be stratified in greater detail in future studies of aneurysm natural history.
近期研究进一步证实，除后循环/后交通（PComm）动脉部位外，前交通（AComm）动脉部位也是动脉瘤破裂的一个重要危险因素。然而，对动脉瘤部位进行更详细分层的研究较少。
我们回顾了7年间在我院连续就诊的747例患者的1013个动脉瘤记录，记录就诊时动脉瘤的部位和破裂状态。
额极/胼周动脉瘤（59%，比值比[OR] 3.07，p = 0.011）、椎动脉/小脑后下动脉（PICA）动脉瘤（53%，OR 2.49，p = 0.0037）、AComm动脉瘤（50%，OR 2.46，p < 0.0001）和PComm动脉瘤（44%，OR 1.77，p = 0.0016）破裂的比例较高。垂体上动脉（SHA）动脉瘤（6%，OR 0.12，p = 0.0001）、颈内动脉（ICA）分叉处动脉瘤（12%，OR 0.27，p = 0.0012）和眼动脉动脉瘤（15%，OR 0.33，p = 0.0002）破裂的比例较低。PComm动脉瘤破裂的比例显示出高于脉络膜前动脉动脉瘤的趋势（OR 2.14，p = 0.09）；然而，与非PComm硬脑膜内ICA动脉瘤相比，脉络膜前动脉动脉瘤破裂的比例显著更高（OR 2.78，p = 0.03）。值得注意的是，SHA动脉瘤与眼动脉动脉瘤相比，较低的破裂率接近统计学意义（OR 0.38，p = 0.10）。
动脉瘤部位对破裂风险有显著影响，在未来动脉瘤自然史的研究中应进行更详细的分层。
