Zhang Jian, Can Anil, Lai Pui Man Rosalind, Mukundan Srinivasan, Castro Victor M, Dligach Dmitriy, Finan Sean, Gainer Vivian S, Shadick Nancy A, Savova Guergana, Murphy Shawn N, Cai Tianxi, Weiss Scott T, Du Rose
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Jiangsu, China.
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
World Neurosurg. 2021 Feb;146:e1318-e1325. doi: 10.1016/j.wneu.2020.11.160. Epub 2020 Dec 9.
To identify clinical and morphologic risk factors correlated with anterior communicating artery (ACoA) aneurysm formation.
Three-dimensional morphologic parameters obtained from computed tomography angiography or digital subtraction angiography from 504 patients with ACoA aneurysms and 201 patients with aneurysms in other locations that were diagnosed at Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016 were evaluated. The presence of hypoplastic and aplastic A1 segments and diameters and angles of surrounding parent and daughter vessels were examined. Univariable and multivariable statistical analyses were performed to determine statistical significance. Sensitivity analyses for small (≤3 mm) aneurysms only were also performed.
Aplastic and hypoplastic A1 segments were more common in the ACoA group (38.9% vs. 6.5% hypoplastic and 22.2% vs. 0.5% aplastic). In multivariable analysis, the presence of a hypoplastic A1 segment was associated with ACoA aneurysms. An A2-ACoA (daughter-daughter) angle was also significantly associated with ACoA aneurysms in multivariable analysis; however, as Pearson's correlation test between aneurysm width and daughter-daughter angle was significant, the daughter-daughter angle was most likely not independently associated with aneurysm presence, but rather might have been a result of the presence of an aneurysm. Subgroup analyses of small aneurysms (≤3 mm) and of unruptured aneurysms showed similar results.
Our results demonstrate that of all the morphologic parameters, the presence of a hypoplastic A1 segment was the only parameter independently associated with the presence of ACoA aneurysms that was not correlated with aneurysm size and could aid as a simple screening parameter.
确定与前交通动脉（ACoA）动脉瘤形成相关的临床和形态学危险因素。
对1990年至2016年间在布莱根妇女医院和麻省总医院诊断的504例ACoA动脉瘤患者以及201例其他部位动脉瘤患者的计算机断层血管造影或数字减影血管造影获得的三维形态学参数进行评估。检查A1段发育不全和发育不良的情况以及周围母血管和子血管的直径和角度。进行单变量和多变量统计分析以确定统计学意义。还仅对小（≤3 mm）动脉瘤进行了敏感性分析。
ACoA组中发育不全和发育不良的A1段更为常见（发育不全分别为38.9%对6.5%，发育不良分别为22.2%对0.5%）。在多变量分析中，A1段发育不全与ACoA动脉瘤相关。多变量分析中，A2-ACoA（子-子）角也与ACoA动脉瘤显著相关；然而，由于动脉瘤宽度与子-子角之间的Pearson相关性检验具有显著性，子-子角很可能并非独立与动脉瘤的存在相关，而可能是动脉瘤存在的结果。小动脉瘤（≤3 mm）和未破裂动脉瘤的亚组分析显示了相似的结果。
我们的结果表明，在所有形态学参数中，A1段发育不全是唯一与ACoA动脉瘤的存在独立相关且与动脉瘤大小无关的参数，可作为一个简单的筛查参数。
