Feng Junqiang, Tang Yudi, You Wei, Jiang Yuhua, Xu Zhengkun, Zhao Yan, Liu Xinke, Lv Jian, Liu Peng, Wei Haining, Mossa-Basha Mahmud, Li Youxiang, Wang Yang, Zhu Chengcheng
Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Front Neurol. 2024 Aug 21;15:1339144. doi: 10.3389/fneur.2024.1339144. eCollection 2024.
The rupture risk of intracranial aneurysms (IAs) is related to their arterial origin, but whether the different segments of the artery have different risks and act as independent risk factors is still unknown. Our study aimed to investigate the rupture risk of IAs in different arterial segments in a large Chinese cohort.
Imaging and clinical data of consecutive patients with IAs diagnosed by Computed Tomography angiography (CTA) from January 2013 to December 2022 were collected. Two neuroradiologists independently identified ruptured and unruptured IAs based on imaging and medical records. The internal carotid artery (ICA), middle cerebral artery (MCA), anterior cerebral artery (ACA), vertebral artery (VA), and posterior cerebral artery (PCA) were segmented according to the Bouthillier and Fischer segmentation methods. Stenoses of the proximal parent vessel were evaluated and documented. The Institutional Review Board (IRB) at Beijing Tiantan Hospital approved this retrospective study.
A total of 3,837 aneurysms {median size 3.5 mm [interquartile range (IQR) 2.6-5.1 mm]; 532 ruptured} were included in this study from 2,968 patients [mean age: 57 years (IQR 50-64); male patients: 1,153]. Ruptured aneurysms were most commonly located in the posterior inferior cerebellar artery (PICA) (52.9%), anterior communicating artery (ACoA) (33.8%), other locations (33.3%), ACA (22.4%), and basilar artery (BA) (21.4%). The locations with the highest likelihood of rupture were the C7 ICA (21.3%), M2 MCA (24.0%), distal MCA (25.0%), and A2 ACA (28.1%). IAs originating from the C7 ( < 0.001), dM1 ( = 0.022), and dA1 ( = 0.021) segments were independent risk factors for rupture. IAs without stenosis of the proximal parent vessel were associated with a higher risk of rupture ( = 0.023).
There are unique associations between the origins of aneurysms from various arterial segments. Aneurysms originating from the anterior communicating artery (ACoA), BA, PICA, A2, dA, C7, and M2 indicate a higher risk of rupture. Aneurysms originating from C4, C5, and C6 indicate a lower risk of rupture. C7 IAs, ACoA IAs, and PICA IAs seem to be independent risk factors.
颅内动脉瘤（IA）的破裂风险与其动脉起源有关，但动脉的不同节段是否具有不同风险并作为独立危险因素仍不清楚。我们的研究旨在调查中国一个大型队列中不同动脉节段IA的破裂风险。
收集2013年1月至2022年12月通过计算机断层扫描血管造影（CTA）诊断为IA的连续患者的影像学和临床数据。两名神经放射科医生根据影像学和病历独立识别破裂和未破裂的IA。根据Bouthillier和Fischer分段方法对颈内动脉（ICA）、大脑中动脉（MCA）、大脑前动脉（ACA）、椎动脉（VA）和大脑后动脉（PCA）进行分段。评估并记录近端母血管的狭窄情况。北京天坛医院的机构审查委员会（IRB）批准了这项回顾性研究。
本研究纳入了来自2968例患者的3837个动脉瘤{中位大小3.5 mm[四分位间距（IQR）2.6 - 5.（此处原文有误，应为5.1）mm]；532个破裂} [平均年龄：57岁（IQR 50 - 64）；男性患者：1153例]。破裂的动脉瘤最常见于小脑后下动脉（PICA）（52.9%）、前交通动脉（ACoA）（33.8%）、其他部位（33.3%）、ACA（22.4%）和基底动脉（BA）（21.4%）。破裂可能性最高的部位是ICA的C7段（21.3%）、MCA的M2段（24.0%）、MCA远端（25.0%）和ACA的A2段（28.1%）。起源于C7段（<0.001）、dM1段（=0.022）和dA1段（=0.021）的IA是破裂的独立危险因素。近端母血管无狭窄的IA破裂风险更高（=0.023）。
不同动脉节段的动脉瘤起源之间存在独特的关联。起源于前交通动脉（ACoA）、BA、PICA、A2、dA、C7和M2的动脉瘤破裂风险较高。起源于C4、C5和C6的动脉瘤破裂风险较低。C7段IA、ACoA段IA和PICA段IA似乎是独立危险因素。
