Roethlisberger Michel, Achermann Rita, Bawarjan Schatlo, Stienen Martin N, Fung Christian, D'Alonzo Donato, Maldaner Nicolai, Ferrari Andrea, Corniola Marco V, Schöni Daniel, Valsecchi Daniele, Maduri Rodolfo, Seule Martin A, Burkhardt Jan-Karl, Marbacher Serge, Bijlenga Philippe, Blackham Kristine A, Bucher Heiner C, Mariani Luigi, Guzman Raphael, Zumofen Daniel W
Department of Neurosurgery, Basel University Hospital, University of Basel, Basel, Switzerland.
Department of Clinical Epidemiology and Biostatistics, Basel University Hospital, University of Basel, Basel, Switzerland.
World Neurosurg. 2018 Mar;111:e199-e205. doi: 10.1016/j.wneu.2017.12.046. Epub 2017 Dec 16.
The literature on multiple intracranial aneurysms (MIA) in patients with aneurysmal subarachnoid hemorrhage (aSAH) focuses largely on risk factor analysis and consists essentially of retrospective cohort studies of limited sample size, or studies in populations outside Europe and North America. The purpose of this cohort study was to identify predictors for aneurysm multiplicity and to investigate the anatomic distribution of MIA in a representative Western cohort of patients with aSAH.
The Swiss Study of Subarachnoid Hemorrhage (SOS) database includes anonymized data from all tertiary neurovascular facilities in Switzerland. The dataset for 2009-2014 was used to compare characteristics of patients with aSAH and MIA and those with a single intracranial aneurysm (SIA) by means of descriptive and multivariate regression analysis.
Among 1689 unselected patients with aSAH, 467 had MIA (prevalence, 27.6%). The location of the ruptured index aneurysm was correlated with the probability of finding bystander aneurysms and predicted their likely anatomic distribution. Patients with a ruptured basilar artery aneurysm (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.30-3.44) or a ruptured middle cerebral artery aneurysm (OR, 1.86; 95% CI, 1.35-2.55) were at the greatest risk for having MIA. Larger size of the index aneurysm (OR per 1 mm, 1.03; 95% CI, 1.01-1.06) was also positively correlated with aneurysm multiplicity. Males were less likely than females to have MIA (OR, 0.79; 95% CI, 0.61-1.01).
In patients with aSAH, the location of the ruptured index aneurysm is correlated with the probability of finding bystander aneurysms, and is predictive of the sites at which bystander aneurysms are most likely to be found.
关于动脉瘤性蛛网膜下腔出血（aSAH）患者的多发性颅内动脉瘤（MIA）的文献主要集中在危险因素分析，且基本上是样本量有限的回顾性队列研究，或者是欧洲和北美以外人群的研究。这项队列研究的目的是确定动脉瘤多发性的预测因素，并调查在具有代表性的西方aSAH患者队列中MIA的解剖分布。
瑞士蛛网膜下腔出血研究（SOS）数据库包含来自瑞士所有三级神经血管设施的匿名数据。使用2009 - 2014年的数据集，通过描述性和多变量回归分析比较aSAH和MIA患者与单一颅内动脉瘤（SIA）患者的特征。
在1689例未经选择的aSAH患者中，467例患有MIA（患病率为27.6%）。破裂的索引动脉瘤的位置与发现旁观者动脉瘤的概率相关，并可预测其可能的解剖分布。基底动脉动脉瘤破裂的患者（比值比[OR]，2.11；95%置信区间[CI]，1.30 - 3.44）或大脑中动脉动脉瘤破裂的患者（OR，1.86；95% CI，1.35 - 2.55）发生MIA的风险最高。索引动脉瘤较大（每1毫米的OR为1.03；95% CI，1.01 - 1.06）也与动脉瘤多发性呈正相关。男性患MIA的可能性低于女性（OR，0.79；95% CI，0.61 - 1.01）。
在aSAH患者中，破裂的索引动脉瘤的位置与发现旁观者动脉瘤的概率相关，并可预测最有可能发现旁观者动脉瘤的部位。
