Stapleton Christopher J, Kumar Jay I, Walcott Brian P, Torok Collin M, Agarwalla Pankaj K, Koch Matthew J, Patel Aman B
Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA Neuroendovascular Program, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Interv Neuroradiol. 2016 Aug;22(4):389-95. doi: 10.1177/1591019916633243. Epub 2016 Feb 27.
Arterial bifurcations are common locations for aneurysm development given the altered hemodynamic forces and shear stress variations present at these locations. Recent reports indicate that a wide basilar artery bifurcation angle is an independent predictor of aneurysm development, growth, and subsequent rupture.
To determine the effect of basilar artery bifurcation angle on rates of initial occlusion, recanalization, and retreatment of basilar artery apex aneurysms following coil embolization, the records of 46 patients with basilar artery apex aneurysms treated with endovascular coil embolization from 2007 to 2013 were analyzed.
A wide basilar artery bifurcation angle was associated with a Raymond-Roy Occlusion Classification (RROC) III occlusion in univariate analysis, but was not a statistically significant factor in multivariate modeling. An increasing basilar artery bifurcation angle was not associated with aneurysm recanalization or retreatment following coil embolization. Increasing packing density (p < .01) was the only statistically significant predictor of a RROC I or II closure. The initial RROC designation was the most powerful predictor of both eventual aneurysm recanalization (p = .01) and retreatment (p = .02). While increasing aneurysm size (p < .01), increasing aneurysm volume (p < .01), and increasing neck size (p < .01) were associated with wide basilar artery bifurcation angles, neck size (p = .03) was the only statistically significant predictor of basilar artery bifurcation angle on multivariate analyses.
Basilar artery bifurcation angle fails to predict rates of initial occlusion, recanalization, and retreatment on multivariate modeling in our series. Basilar artery apex aneurysm neck size independently correlates with basilar artery bifurcation angle.
鉴于动脉分叉处存在血流动力学改变和剪切应力变化，此处是动脉瘤形成的常见部位。近期报告表明，基底动脉分叉角度大是动脉瘤形成、生长及随后破裂的独立预测因素。
为确定基底动脉分叉角度对基底动脉尖部动脉瘤弹簧圈栓塞术后初始闭塞率、再通率及再次治疗率的影响，分析了2007年至2013年接受血管内弹簧圈栓塞治疗的46例基底动脉尖部动脉瘤患者的记录。
在单因素分析中，基底动脉分叉角度大与雷蒙德 - 罗伊闭塞分类（RROC）III级闭塞相关，但在多变量建模中并非统计学显著因素。基底动脉分叉角度增加与弹簧圈栓塞术后动脉瘤再通或再次治疗无关。填塞密度增加（p < 0.01）是RROC I或II级闭塞的唯一具有统计学意义的预测因素。初始RROC分级是最终动脉瘤再通（p = 0.01）和再次治疗（p = 0.02）的最有力预测因素。虽然动脉瘤大小增加（p < 0.01）、动脉瘤体积增加（p < 0.01）和瘤颈大小增加（p < 0.01）与基底动脉分叉角度大相关，但在多变量分析中，瘤颈大小（p = 0.03）是基底动脉分叉角度的唯一具有统计学意义的预测因素。
在我们的系列研究中，基底动脉分叉角度在多变量建模中未能预测初始闭塞率、再通率及再次治疗率。基底动脉尖部动脉瘤瘤颈大小与基底动脉分叉角度独立相关。
