Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
Sci Rep. 2021 Feb 26;11(1):4791. doi: 10.1038/s41598-021-84315-5.
We present a cohort of patients with anterior communicating artery (ACoA) aneurysms to investigate morphological characteristics and clinical factors associated with rupture of the aneurysms. 505 patients with ACoA aneurysms were identified at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016, with available CT angiography (CTA). Three-dimensional (3D) reconstructions were performed to evaluate aneurysmal morphologic features, including location, projection, irregularity, the presence of daughter dome, height, height/width ratio, and relationships between surrounding vessels. Patient risk factors assessed included patient age, sex, tobacco use, alcohol use, and family history of aneurysms and aneurysmal subarachnoid hemorrhage. Logistic regression was used to build a predictive ACoA score for rupture. Morphologic features associated with ruptured ACoA aneurysms were the presence of a daughter dome (OR 21.4, 95% CI 10.6-43.1), smaller neck diameter (OR 0.55, 95% CI 0.42-0.71), larger aspect ratio (OR 3.57, 95% CI 2.05-6.24), larger flow angle (OR 1.03, 95% CI 1.02-1.05), and smaller ipsilateral A2-ACoA angle (OR 0.98, 95% CI 0.97-1.00). Tobacco use was predominantly associated with morphological factors intrinsic to the aneurysm that were associated with rupture while younger age was also associated with morphologic features extrinsic to the aneurysm that were associated with rupture. The ACoA score had good predictive capacity for rupture with AUC = 0.92 using the 0.632 bootstrap cross-validation for correction of overfitting bias. Ruptured ACoA aneurysms were associated with morphological features that are simple to assess using a simple scoring system. Tobacco use and younger age were predominantly associated with intrinsic and extrinsic morphological features characteristic of rupture, respectively.
我们报告了一组前交通动脉瘤（ACoA）患者的病例，旨在研究与动脉瘤破裂相关的形态学特征和临床因素。1990 年至 2016 年间，在布莱根妇女医院和马萨诸塞州综合医院共发现 505 例 ACoA 动脉瘤患者，均具有可利用的 CT 血管造影（CTA）。通过三维（3D）重建评估动脉瘤的形态特征，包括位置、投影、不规则性、子瘤顶的存在、高度、高度/宽度比，以及与周围血管的关系。评估的患者危险因素包括患者年龄、性别、吸烟、饮酒、家族性动脉瘤和动脉瘤性蛛网膜下腔出血病史。采用逻辑回归建立破裂的 ACoA 评分预测模型。与破裂的 ACoA 动脉瘤相关的形态学特征包括子瘤顶的存在（OR 21.4，95%CI 10.6-43.1）、较小的瘤颈直径（OR 0.55，95%CI 0.42-0.71）、较大的长宽比（OR 3.57，95%CI 2.05-6.24）、较大的血流角度（OR 1.03，95%CI 1.02-1.05）和较小的同侧 A2-ACoA 角度（OR 0.98，95%CI 0.97-1.00）。吸烟主要与与破裂相关的动脉瘤内在形态学因素相关，而年龄较小也与与破裂相关的动脉瘤外在形态学特征相关。ACoA 评分具有良好的破裂预测能力，采用 0.632 的 Bootstrap 交叉验证校正过拟合偏倚后 AUC 为 0.92。破裂的 ACoA 动脉瘤与使用简单评分系统即可评估的形态学特征相关。吸烟和年龄较小主要与破裂的内在和外在形态学特征相关。
