Xu Mingwei, Lv Nan, Sun Kai, Hong Rujun, Wang Hao, Wang Xuhui, Xu Lunshan, Chen Lizhao, Xu Minhui
Department of Neurosurgery, Daping Hospital, Army Medical University, Chongqing, China.
Department of Neurosurgery, Changhai Hospital, Naval Medical University, Shanghai, China.
Front Aging Neurosci. 2022 Feb 18;14:835373. doi: 10.3389/fnagi.2022.835373. eCollection 2022.
The treatment of unruptured small intracranial aneurysms remains controversial. A distinguishing characteristic of A1 segment aneurysms is that they tend to rupture when they are small, which may be related to their distinctive morphology and hemodynamics. Our study sought to investigate the rupture risk factors of A1 segment aneurysms by analyzing the clinical risk factors, morphology, and hemodynamic characteristics of A1 segment aneurysms.
We retrospectively enrolled 49 (23 ruptured, 26 unruptured) consecutive patients presenting to our institute with A1 segment aneurysms between January 2010 and March 2020. Independent risk factors associated with the rupture of A1 segment aneurysms were analyzed by multivariate regression analysis in the ruptured group and unruptured group.
Clinical risk factors, including age, sex, hypertension, smoking history, and SAH family history revealed no difference between the ruptured and unruptured groups. The ruptured group presented a significantly larger size (Size, = 0.007), aspect ratio (AR, = 0.002), size ratio (SR, = 0.001), bottleneck index (BN, = 0.016), dome-to-neck ratio (DN, = 0.001), and oscillatory shear index (OSI) ( = 0.001) than the unruptured group. The normalized wall shear stress (NWSS) of the ruptured aneurysms was lower than the unruptured group ( = 0.001). In the multivariate regression analysis, only SR (OR = 3.672, = 0.003) and NWSS (OR = 0.474, = 0.01) were independent risk factors in the A1 segment aneurysm rupture.
A higher SR and lower NWSS revealed a close connection with the rupture of A1 segment aneurysms in our study, thus providing a reference for clinical decision-making in treating A1 segment unruptured aneurysms.
未破裂小型颅内动脉瘤的治疗仍存在争议。A1段动脉瘤的一个显著特征是它们在体积较小时往往容易破裂，这可能与其独特的形态和血流动力学有关。我们的研究旨在通过分析A1段动脉瘤的临床危险因素、形态和血流动力学特征来探讨A1段动脉瘤的破裂危险因素。
我们回顾性纳入了2010年1月至2020年3月期间在我院连续就诊的49例A1段动脉瘤患者（23例破裂，26例未破裂）。通过多因素回归分析对破裂组和未破裂组中与A1段动脉瘤破裂相关的独立危险因素进行分析。
临床危险因素，包括年龄、性别、高血压、吸烟史和蛛网膜下腔出血家族史，在破裂组和未破裂组之间没有差异。破裂组的大小（大小，=0.007）、纵横比（AR，=0.002）、大小比（SR，=0.001）、瓶颈指数（BN，=0.016）、瘤顶颈比（DN，=0.001）和振荡剪切指数（OSI）（=0.001）均显著大于未破裂组。破裂动脉瘤的归一化壁面剪应力（NWSS）低于未破裂组（=0.001）。在多因素回归分析中，只有SR（OR=3.672，=0.003）和NWSS（OR=0.474，=0.01）是A1段动脉瘤破裂的独立危险因素。
在我们的研究中，较高的SR和较低的NWSS与A1段动脉瘤的破裂密切相关，从而为治疗A1段未破裂动脉瘤的临床决策提供参考。
