Xu Ting, Lin Boli, Liu Shuailiang, Shao Xiaotong, Xia Nengzhi, Zhang Yue, Xu Haoli, Yang Yunjun, Zhong Ming, Zhuge Qichuan, Zhao Bing, Chen Weijian
Department of Radiology, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
Department of Neurosurgery, The first affiliated hospital of Wenzhou Medical University, Wenzhou, China.
J Neurointerv Surg. 2017 Mar;9(3):278-282. doi: 10.1136/neurintsurg-2016-012294. Epub 2016 Mar 23.
Anterior communicating artery (AcoA) aneurysms have a high rupture risk, and ruptured AcoA aneurysms tend to be smaller than other intracranial aneurysms. We aimed to determine the incidence and morphologic predictors of aneurysm rupture of very small AcoA aneurysms.
We conducted a retrospective analysis of 519 consecutive patients with single AcoA aneurysms between December 2007 and February 2015 in our hospital. Aneurysm morphologies were re-measured using CT angiography images. Very small aneurysms were defined as those with a maximum size ≤3 mm, and small aneurysms were defined as those with a maximum size ≤5 mm. Multivariate regression analyses were used to determine the association between aneurysm morphology and aneurysm rupture status.
Of the 474 ruptured AcoA aneurysms, 134 (28.3%) aneurysms were very small and 278 (58.6%) aneurysms were small. In the univariate analysis for very small aneurysms, larger aneurysm size (p=0.037), larger size ratio (p=0.002), higher aneurysm height (p=0.038), smaller vessel size (p=0.012), and dominant A1 segment configuration (p=0.011) were associated with aneurysm rupture. Multivariate analysis revealed that a larger size ratio was independently associated with the rupture status of the very small aneurysms (OR 3.69, 95% CI 1.5 to 9.0; p=0.004), and larger aneurysm size, larger size ratio, and dominant A1 segment configuration were associated with the rupture of small aneurysms.
About one-third of ruptured AcoA aneurysms were very small. A larger size ratio, rather than other aneurysm morphologies, was independently associated with the rupture of very small AcoA aneurysms.
前交通动脉（AcoA）动脉瘤破裂风险高，且破裂的AcoA动脉瘤往往比其他颅内动脉瘤小。我们旨在确定非常小的AcoA动脉瘤破裂的发生率及形态学预测因素。
我们对2007年12月至2015年2月期间我院连续收治的519例单发AcoA动脉瘤患者进行了回顾性分析。使用CT血管造影图像重新测量动脉瘤形态。非常小的动脉瘤定义为最大直径≤3 mm的动脉瘤，小动脉瘤定义为最大直径≤5 mm的动脉瘤。采用多因素回归分析确定动脉瘤形态与动脉瘤破裂状态之间的关联。
在474例破裂的AcoA动脉瘤中，134例（28.3%）为非常小的动脉瘤，278例（58.6%）为小动脉瘤。在对非常小的动脉瘤的单因素分析中，较大的动脉瘤尺寸（p=0.037）、较大的尺寸比（p=0.002）、较高的动脉瘤高度（p=0.038）、较小的血管尺寸（p=0.012）和优势A1段形态（p=0.011）与动脉瘤破裂相关。多因素分析显示，较大的尺寸比与非常小的动脉瘤破裂状态独立相关（OR 3.69，95% CI 1.5至9.0；p=0.004），较大的动脉瘤尺寸、较大的尺寸比和优势A1段形态与小动脉瘤破裂相关。
约三分之一的破裂AcoA动脉瘤非常小。较大的尺寸比而非其他动脉瘤形态与非常小的AcoA动脉瘤破裂独立相关。
