Department of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, Nanjing, China.
Department of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, Nanjing, China; Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
World Neurosurg. 2021 Sep;153:e59-e65. doi: 10.1016/j.wneu.2021.06.007. Epub 2021 Jun 13.
Congenital hypoplasia or aplasia of the A1 segment of the anterior cerebral artery is associated with an increased incidence of berry aneurysms at the anterior communicating artery (ACoA) complex. We analyzed the factors contributing to ACoA aneurysm rupture.
We retrospectively analyzed the data of patients with ACoA aneurysms who had undergone cerebral angiography from July 2008 to January 2020. The risk factors for rupture were identified using univariate and multivariate logistic regression models. We used the imaging data of patients without intracranial aneurysms as the control population.
We confirmed 253 aneurysms in 253 patients, including 137 men (54.2%) and 116 women (45.8%), with a mean age of 54.6 ± 12.7 years. Of the 253 aneurysms, 218 (86.2%) were ruptured and 35 (13.8%) were unruptured, with a mean diameter of 4.56 ± 1.96 mm and 3.24 ± 1.79 mm, respectively. Of the 253 aneurysms, 176 (69.6%) were <5 mm in diameter, 146 (83%) of which were ruptured. Of the 253 patients, 141 (55.7%) exhibited A1 segment hypoplasia or aplasia: 106 (41.9%) on the right side of the circle of Willis and 35 (13.8%) on the left. Multivariate logistic regression analysis identified the aneurysm diameter (odds ratio, 4.11; 95% confidence interval, 1.601-16.07; P = 0.003) and age <65 years (odds ratio, 0.17; 95% confidence interval, 0.062-0.48; P < 0.001) as independent predictors of rupture.
ACoA aneurysms are small (<5 mm) and have a high risk of rupture. A1 segment hypoplasia or aplasia is a risk factor for ACoA aneurysm formation; however, it was uncorrelated with aneurysm diameter or rupture risk. The strongest independent risk factors for rupture were age <65 years and aneurysm diameter.
大脑前动脉 A1 段先天性发育不良或发育不全与前交通动脉（ACoA）复合体处的浆果状动脉瘤发生率增加有关。我们分析了导致 ACoA 动脉瘤破裂的因素。
我们回顾性分析了 2008 年 7 月至 2020 年 1 月期间接受脑血管造影的 ACoA 动脉瘤患者的数据。使用单变量和多变量逻辑回归模型确定破裂的危险因素。我们使用没有颅内动脉瘤的患者的影像学数据作为对照人群。
我们共确认了 253 名患者的 253 个动脉瘤，其中 137 名男性（54.2%）和 116 名女性（45.8%），平均年龄为 54.6±12.7 岁。在 253 个动脉瘤中，218 个（86.2%）破裂，35 个（13.8%）未破裂，平均直径分别为 4.56±1.96mm 和 3.24±1.79mm。在 253 个动脉瘤中，直径<5mm 的有 176 个（69.6%），其中 146 个（83%）破裂。在 253 名患者中，有 141 名（55.7%）表现为 A1 段发育不良或发育不全：106 名（41.9%）在 Willis 环的右侧，35 名（13.8%）在左侧。多变量逻辑回归分析确定动脉瘤直径（优势比，4.11；95%置信区间，1.601-16.07；P=0.003）和年龄<65 岁（优势比，0.17；95%置信区间，0.062-0.48；P<0.001）是破裂的独立预测因子。
ACoA 动脉瘤较小（<5mm）且破裂风险较高。A1 段发育不良或发育不全是 ACoA 动脉瘤形成的危险因素；然而，它与动脉瘤直径或破裂风险无关。破裂的最强独立危险因素是年龄<65 岁和动脉瘤直径。
