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过去两个世纪的脑动脉瘤趋势:需要早期筛查。

Trend of cerebral aneurysms over the past two centuries: need for early screening.

机构信息

Human Anatomy, University of South Australia, Adelaide, South Australia, Australia

School of Biomedicine, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.

出版信息

BMJ Open. 2024 Feb 27;14(2):e081290. doi: 10.1136/bmjopen-2023-081290.

Abstract

OBJECTIVE

Cerebral aneurysms (CAs) are linked to variations in the cerebral basal arterial network (CBAN). This study aimed to find the optimal age for screening to detect brain arterial variations and predict aneurysms before rupture.

DESIGN

An observational, quantitative and retrospective research.

SETTING

The study analysed 1127 cases of CAs published from 1761 to 1938. Additionally, CT angiography images of 173-patients at the Royal Adelaide Hospital (RAH), South Australia between 2011 and 2019 were examined for the presence and the location of aneurysms in CBAN.

PARTICIPANTS

The data were collected from patients at RAH and 407 published sources, including males and females across the entire age range, up to 100 years old.

OUTCOME MEASURES AND RESULTS

Data, CAs cases, from 1761 to 1938 included (526 males, 573 females and 28 unknown sexes). The age of these patients varied from 18 months to 89 years (mean age=42, SD=18). Approximately 11.5% of the CAs occurred in patients aged <20 years. Among the 1078 aneurysms whose location was reported, 76% were located in the internal carotid (IC), middle cerebral (MC) and anterior communicating artery complex (AcomAC) regions, while the remaining 24% were in the vertebrobasilar region. Among 173 patients from RAH aged between 18 and 100 years (male=83 and female=90, mean age=60, SD=16), 94% of the CAs were found in the IC, MC and AcomAC regions. The pattern of aneurysm occurrence, as indicated by values at the 25th, 50th and 75th percentiles, along with the minimum and maximum patient ages, has remained consistent from 1761 to 2019.

CONCLUSION

The distribution pattern of CAs in relation to sex, age and locations in the CBAN, remained steady over the last 260 years resulting in risk of strokes early in life. Therefore, early screening for CBAN segment variations is advised for stroke prevention if possible.

摘要

目的

脑动脉瘤(CA)与脑基底动脉网络(CBAN)的变异有关。本研究旨在找到筛查以检测动脉变异和预测破裂前动脉瘤的最佳年龄。

设计

观察性、定量和回顾性研究。

地点

该研究分析了 1761 年至 1938 年间发表的 1127 例 CA 病例。此外,还对 2011 年至 2019 年间南澳大利亚皇家阿德莱德医院(RAH)的 173 名患者的 CT 血管造影图像进行了检查,以确定 CBAN 中动脉瘤的存在和位置。

参与者

数据来自 RAH 的患者和 407 个已发表的来源,包括整个年龄段的男性和女性,年龄最大为 100 岁。

测量结果和结果

数据包括 1761 年至 1938 年的 CA 病例(526 名男性,573 名女性和 28 名未知性别)。这些患者的年龄从 18 个月到 89 岁不等(平均年龄=42,标准差=18)。大约 11.5%的 CA 发生在 20 岁以下的患者中。在报告了位置的 1078 个动脉瘤中,76%位于颈内动脉(IC)、大脑中动脉(MC)和前交通动脉复合体(AcomAC)区域,而其余 24%位于椎基底动脉区域。在 RAH 的 173 名年龄在 18 至 100 岁的患者中(男性=83 名,女性=90 名,平均年龄=60,标准差=16),94%的 CA 位于 IC、MC 和 AcomAC 区域。自 1761 年至 2019 年,动脉瘤发生的模式(以第 25、50 和 75 百分位数以及最小和最大患者年龄的值表示)保持一致。

结论

在过去的 260 年中,CBAN 中与性别、年龄和位置相关的 CA 分布模式保持稳定,导致生命早期发生中风的风险增加。因此,如果可能的话,建议早期筛查 CBAN 节段变异以预防中风。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/770b/10900367/2d6b37b6b324/bmjopen-2023-081290f01.jpg

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