Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
Sci Rep. 2020 Jul 14;10(1):11545. doi: 10.1038/s41598-020-68276-9.
Risk of intracranial aneurysm rupture could be affected by geometric features of intracranial aneurysms and the surrounding vasculature in a location specific manner. Our goal is to investigate the morphological characteristics associated with ruptured posterior communicating artery (PCoA) aneurysms, as well as patient factors associated with the morphological parameters. Three-dimensional morphological parameters in 409 patients with 432 PCoA aneurysms diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016 who had available CT angiography (CTA) or digital subtraction angiography (DSA) were evaluated. Morphological parameters examined included aneurysm wall irregularity, presence of a daughter dome, presence of hypoplastic or aplastic A1 arteries and hypoplastic or fetal PCoA, perpendicular height, width, neck diameter, aspect and size ratio, height/width ratio, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine the association of morphological parameters with rupture of PCoA aneurysms. Additional analyses were performed to determine the association of patient factors with the morphological parameters. Irregular, multilobed PCoA aneurysms with larger height/width ratios and larger flow angles were associated with ruptured PCoA aneurysms, whereas perpendicular height was inversely associated with rupture in a multivariable model. Older age was associated with lower aspect ratio, with a trend towards lower height/width ratio and smaller flow angle, features that are associated with a lower rupture risk. Morphological parameters are easy to assess and could help in risk stratification in patients with unruptured PCoA aneurysms. PCoA aneurysms diagnosed at older age have morphological features associated with lower risk.
颅内动脉瘤破裂的风险可能受到颅内动脉瘤和特定部位血管周围的几何特征的影响。我们的目标是研究与破裂的后交通动脉瘤（PCoA）相关的形态特征，以及与形态参数相关的患者因素。评估了 1990 年至 2016 年期间在布莱根妇女医院和马萨诸塞州综合医院诊断的 409 名患者的 432 个 PCoA 动脉瘤，这些患者有 CT 血管造影（CTA）或数字减影血管造影（DSA）检查，可用三维形态参数。检查的形态参数包括动脉瘤壁不规则、存在子瘤顶、存在发育不良或无发育 A1 动脉和发育不良或胎儿 PCoA、垂直高度、宽度、颈部直径、侧面和大小比、高度/宽度比以及周围母瘤和子瘤的直径和角度。进行了单变量和多变量统计分析，以确定形态参数与 PCoA 动脉瘤破裂的关系。进行了额外的分析，以确定患者因素与形态参数的关系。不规则、多叶 PCoA 动脉瘤，其高度/宽度比较大且流量角度较大，与破裂的 PCoA 动脉瘤相关，而垂直高度在多变量模型中与破裂呈负相关。年龄较大与较低的纵横比相关，与较低的高度/宽度比和较小的流量角度呈趋势相关，这些特征与较低的破裂风险相关。形态参数易于评估，可有助于未破裂的 PCoA 动脉瘤患者的风险分层。年龄较大诊断出的 PCoA 动脉瘤具有与较低风险相关的形态特征。
