动脉瘤的分叉位置和大小增长与未破裂颅内动脉瘤的不规则形状显著相关。

Bifurcation Location and Growth of Aneurysm Size Are Significantly Associated with an Irregular Shape of Unruptured Intracranial Aneurysms.

作者信息

Feng Xin, Zhang Baorui, Guo Erkang, Wang Luyao, Qian Zenguhi, Liu Peng, Wen Xiaolong, Xu Wenjuan, Jiang Chuhan, Li Youxiang, Wu Zhongxue, Liu Aihua

机构信息

Beijing Neurosurgical Institute and Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

出版信息

World Neurosurg. 2017 Nov;107:255-262. doi: 10.1016/j.wneu.2017.07.063. Epub 2017 Jul 20.

DOI:10.1016/j.wneu.2017.07.063

PMID:28735142

Abstract

BACKGROUND AND OBJECTIVE

Previous studies firmly proved that an irregular aneurysmal shape was associated strongly with intracranial aneurysm (IA) rupture, but it is unclear how irregularly shaped IAs form. We aimed to identify the factors related to irregular shape of IAs.

METHODS

We retrospectively analyzed of consecutive patients evaluated or treated for IA at our institution from June 2015 to July 2016. According to the imaging morphology of aneurysm, the enrolled patients were divided into irregular and regular group. Demographic data and imaging data of the 2 groups were compared to identify the factors related to aneurismal irregular shape.

RESULTS

There were 429 aneurysms (180 irregular and 249 regular aneurysms), including 315 unruptured aneurysms and 114 ruptured aneurysms. Most unruptured aneurysms occurred in the internal carotid arteries (53.3%), anterior communicating artery (10.8%), and posterior communicating artery (10.8%), anterior cerebral artery (5.4%), middle cerebral artery (9.8%), and posterior circulation (9.8%). In univariate analysis, for unruptured aneurysm, irregular aneurysmal shape was significantly related to aneurysm size (P = 0.009), aspect ratio (P = 0.003), size ratio (P = 0.002), and location at the bifurcation (P = 0.009) but not with smoking status, hypertension, hyperlipidemia, or diabetes mellitus. In multivariate logistic analysis, irregular aneurysms occurred mainly in unruptured aneurysms with a larger size (diameter ≥5 mm; odds ratio [OR] 2.106; 95% confidence interval [CI] 1.183-3.749; P = 0.011); location at a bifurcation (OR 2.017; 95% CI 1.191-3.413; P = 0.006), and aspect ratio (≥0.8; OR 4.992; 95% CI 1.318-18.915; P = 0.018).

CONCLUSIONS

Location at a bifurcation, an increased aneurysm size, and greater aspect ratio are significant independent factors associated with an irregular shape in unruptured IAs but not with smoking status, hypertension, hyperlipidemia, or diabetes mellitus.

摘要

背景与目的

既往研究确凿证明，不规则的动脉瘤形态与颅内动脉瘤（IA）破裂密切相关，但尚不清楚形态不规则的IA是如何形成的。我们旨在确定与IA不规则形态相关的因素。

方法

我们回顾性分析了2015年6月至2016年7月在本机构接受IA评估或治疗的连续患者。根据动脉瘤的影像形态，将纳入的患者分为不规则组和规则组。比较两组的人口统计学数据和影像数据，以确定与动脉瘤不规则形态相关的因素。

结果

共有429个动脉瘤（180个不规则动脉瘤和249个规则动脉瘤），包括315个未破裂动脉瘤和114个破裂动脉瘤。大多数未破裂动脉瘤发生在颈内动脉（53.3%）、前交通动脉（10.8%）、后交通动脉（10.8%）、大脑前动脉（5.4%）、大脑中动脉（9.8%）和后循环（9.8%）。在单因素分析中，对于未破裂动脉瘤，不规则的动脉瘤形态与动脉瘤大小（P = 0.009）、纵横比（P = 0.003）、大小比（P = 0.002）以及分叉处位置（P = 0.009）显著相关，但与吸烟状况、高血压、高脂血症或糖尿病无关。在多因素逻辑回归分析中，不规则动脉瘤主要发生在较大尺寸（直径≥5 mm；比值比[OR] 2.106；95%置信区间[CI] 1.183 - 3.749；P = 0.011）的未破裂动脉瘤中；位于分叉处（OR 2.017；95% CI 1.191 - 3.413；P = 0.006），以及纵横比（≥0.8；OR 4.992；95% CI 1.318 - 18.915；P = 0.018）。