Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka City, Saitama, Japan.
Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka City, Saitama, Japan.
World Neurosurg. 2022 Aug;164:e1087-e1093. doi: 10.1016/j.wneu.2022.05.108. Epub 2022 May 29.
Although small unruptured aneurysms rarely rupture, many patients with subarachnoid hemorrhage (SAH) have ruptured small, especially very small intracranial aneurysms (VSIAs; <3 mm) in clinical practice. We aimed to clarify the proportion and clinical features of patients with SAH with ruptured VSIAs.
609 patients with ruptured intracranial aneurysms diagnosed at our institution from January 2012 to December 2018 were retrospectively analyzed. We classified patients into 2 groups based on ruptured aneurysm size: VSIAs or non-VSIAs (≥3 mm). We analyzed age, sex, location of aneurysms, World Federation of Neurological Surgeons grade on admission, treatment modality, and outcome at discharge.
Among 609 patients, 103 had ruptured VSIAs. The proportion of young patients (age <40 years) was greater in the VSIA group than the non-VSIA group (10.7% vs. 3.6%, P = 0.002). The proportions of VSIAs located in the middle cerebral and vertebrobasilar arteries were relatively low and high, respectively (P = 0.002, 0.005). Significantly more patients with VSIAs than those with non-VSIAs were classified under World Federation of Neurological Surgeons grade I-III (70.9% vs. 56.3%, P = 0.006). Coil embolization was preferred for VSIAs (68.0% vs. 32.0%, P = 0.006). Outcomes were more favorable in the VSIA group than in the non-VSIA group.
Small unruptured aneurysms rarely rupture; however, many patients with SAH have ruptured VSIAs in clinical practice. We observed that VSIA rates among ruptured aneurysms were fairly high. Age, posterior circulation location, and preferable outcome may be important clinical characteristics of ruptured VSIAs.
尽管小的未破裂动脉瘤很少破裂，但在临床实践中，许多蛛网膜下腔出血（SAH）患者的破裂动脉瘤很小，尤其是非常小的颅内动脉瘤（VSIA；<3mm）。我们旨在阐明 SAH 伴破裂 VSIA 患者的比例和临床特征。
回顾性分析 2012 年 1 月至 2018 年 12 月我院诊断的 609 例破裂颅内动脉瘤患者。我们根据破裂动脉瘤的大小将患者分为 2 组：VSIA 或非 VSIA（≥3mm）。分析年龄、性别、动脉瘤位置、入院时世界神经外科学会分级、治疗方式及出院时结局。
在 609 例患者中，103 例有破裂 VSIA。VSIA 组中青年患者（<40 岁）比例高于非 VSIA 组（10.7% vs. 3.6%，P=0.002）。VSIA 位于大脑中动脉和椎基底动脉的比例较低和较高（P=0.002，0.005）。与非 VSIA 组相比，VSIA 组更倾向于分级为 I-III 级（70.9% vs. 56.3%，P=0.006）。VSIA 组更倾向于采用血管内线圈栓塞治疗（68.0% vs. 32.0%，P=0.006）。VSIA 组结局优于非 VSIA 组。
未破裂的小动脉瘤很少破裂；然而，在临床实践中，许多 SAH 患者有破裂的 VSIA。我们观察到破裂动脉瘤中 VSIA 的比例相当高。年龄、后循环位置和较好的结局可能是破裂 VSIA 的重要临床特征。
