大脑中动脉分叉形态差异与动脉瘤形成的相关性：系统评价和荟萃分析。

The Association of Morphological Differences of Middle Cerebral Artery Bifurcation and Aneurysm Formation: A Systematic Review and Meta-Analysis.

机构信息

Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.

Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.

出版信息

World Neurosurg. 2022 Nov;167:17-27. doi: 10.1016/j.wneu.2022.08.075. Epub 2022 Aug 24.

DOI:10.1016/j.wneu.2022.08.075

PMID:36028112

Abstract

OBJECTIVE

We explored the relationships between morphological parameters of middle cerebral artery (MCA) bifurcations based on imaging and the development of middle cerebral aneurysms. Artery bifurcations can form disordered hemodynamics which can promote the development of aneurysms, whereas the hemodynamic environment at the bifurcation tip is highly reliant on the bifurcation's geometry.

METHODS

We searched 3 electronic databases for all relevant, publicly available publications as of March 18, 2022. Through the screening of abstracts and full texts, a meta-analysis was performed to compare the daughter-to-daughter angle, the inclination angle (γ), and the parent vessel diameter of MCA bifurcations between patients in MCA aneurysm and non-aneurysm controls.

RESULTS

Ten articles describing 1012 patients with MCA aneurysms and 1106 control individuals without aneurysms were included in the analysis. The aneurysm group showed a larger daughter-to-daughter branch angle at MCA bifurcations than the non-aneurysm group (weighted mean difference [WMD] = 42.00; 95% confidence interval [CI], 33.77 to 50.23; P < 0.00001). The daughter-to-daughter angle was also larger in the MCA aneurysm group with than without an aneurysm side branch (WMD = 37.03; 95% CI, 26.57 to 47.50; P < 0.00001), and in the MCA aneurysm group than in the non-aneurysm control group (WMD = 41.87; 95% CI, 29.19 to 54.54; P < 0.00001). The aneurysm group had a larger inclination angle than the control group (WMD = 28.73; 95% CI, 18.78 to 38.69; P < 0.00001). In patients with a MCA aneurysm, the parent vessel of the branch with the MCA aneurysm tended to be smaller in diameter than the contralateral branch without the aneurysm (WMD = -0.12; 95% CI, -0.24 to 0.00; P = 0.05).

CONCLUSIONS

A larger daughter-to-daughter angle and larger inclination angle at MCA bifurcations are closely related to MCA bifurcation aneurysms. The parent vessel diameter is negatively related to MCA bifurcation aneurysms.

摘要

目的

我们探讨了基于影像的大脑中动脉（MCA）分叉形态参数与大脑中动脉瘤发展之间的关系。动脉分叉处可能形成紊乱的血流动力学，从而促进动脉瘤的发展，而分叉尖端的血流动力学环境高度依赖于分叉的几何形状。

方法

我们在截至 2022 年 3 月 18 日的所有公开可用的电子数据库中搜索了所有相关的文献。通过对摘要和全文的筛选，对 MCA 分叉处的子叉角度、倾斜角（γ）和 MCA 分叉处母血管直径进行了比较分析，比较对象为 MCA 动脉瘤患者和无动脉瘤对照者。

结果

纳入的分析包括 10 篇描述 1012 例 MCA 动脉瘤患者和 1106 例无动脉瘤对照者的文章。与无动脉瘤对照组相比，动脉瘤组 MCA 分叉处的子叉角度更大（加权均数差 [WMD] = 42.00；95%置信区间 [CI]，33.77 至 50.23；P < 0.00001）。有和无 MCA 动脉瘤侧支的 MCA 动脉瘤组的子叉角度也更大（WMD = 37.03；95%CI，26.57 至 47.50；P < 0.00001），且比无动脉瘤对照组更大（WMD = 41.87；95%CI，29.19 至 54.54；P < 0.00001）。动脉瘤组的倾斜角大于对照组（WMD = 28.73；95%CI，18.78 至 38.69；P < 0.00001）。在 MCA 动脉瘤患者中，分支 MCA 动脉瘤的母血管直径往往小于对侧无动脉瘤的分支（WMD = -0.12；95%CI，-0.24 至 0.00；P = 0.05）。