颈内动脉分叉处的动脉瘤形成与分叉处的血管几何形态有关。
Aneurysm Formation at the Internal Carotid Artery Bifurcation Is Related to the Vascular Geometry of the Bifurcation.
作者信息
Akdağ Rifat, Soylu Ugur, Uçkun Özhan Merzuk, Polat Ömer, Gürpınar İdris, Dağlıoğlu Ergün
机构信息
Clinic of Neurosurgery Bursa, Bursa Yüksek İhtisas Training and Research Hospital, University of Health Science, Üsküdar 34668, Türkiye.
Department of Neurosurgery İzmir, Medicana International Izmir Hospital, Konak 35170, Türkiye.
出版信息
Brain Sci. 2024 Dec 12;14(12):1247. doi: 10.3390/brainsci14121247.
BACKGROUND
In this study, we aimed to comparatively evaluate the morphology of internal carotid artery (ICA) bifurcations with and without aneurysms and identify risk factors for aneurysm development that are associated with the bifurcation geometry.
METHOD
In this two-center study, the computerized tomography angiography data of 1512 patients were evaluated. The study included 64 (4.2%) patients with ICA bifurcation aneurysms (ICAbifAn) and patients with anterior circulation aneurysms (non-ICAbifAn). ICA (P1) was defined as the parent artery, and the middle (M1) and anterior (A1) cerebral artery segments were defined as daughter arteries. We measured the diameters of the P1, M1, and A1 and their ratios (BifSR) to identify the risk factors. In addition, we calculated the bifurcation angle in two ways by measuring all angles between the P1 and daughter arteries and compared these two methods. The first method was the angle between the M1 and A1 (α), and the second was the sum of the angles between the P1 and daughter arteries (BifA).
RESULT
A total of 163 patients who met the inclusion criteria were included in this study: 58 patients in the ICAbifAn group and 105 patients in the non-ICAbifAn group. A univariate logistic regression analysis revealed that the P1, BifSR, α, and BifA measurements were significant predictors of aneurysm formation. However, after a multivariate analysis, only the BifA angle retained its significance (OR, 0.911 (0.877-0.946), < 0.001). In the ROC curve, the optimal BifA threshold for accurately differentiating between an ICAbifAn and non-aneurysmal bifurcation was 210° (area under the curve (AUC), 0.81; sensitivity, 69%; and specificity, 87%). The α angle had an AUC of 0.68.
CONCLUSIONS
These results suggest that bifurcation geometry plays a significant role in the likelihood of aneurysm formation. We also showed that the BifA was more predictive of aneurysm formation than the α angle.
背景
在本研究中，我们旨在比较评估有和没有动脉瘤的颈内动脉（ICA）分叉处的形态，并确定与分叉几何形状相关的动脉瘤形成危险因素。
方法
在这项双中心研究中，对1512例患者的计算机断层血管造影数据进行了评估。该研究包括64例（4.2%）患有ICA分叉动脉瘤（ICAbifAn）的患者和患有前循环动脉瘤的患者（非ICAbifAn）。ICA（P1）被定义为母动脉，大脑中动脉（M1）和大脑前动脉（A1）段被定义为子动脉。我们测量了P1、M1和A1的直径及其比值（BifSR）以确定危险因素。此外，我们通过测量P1与子动脉之间的所有角度，以两种方式计算分叉角度，并比较这两种方法。第一种方法是M1与A1之间的角度（α），第二种方法是P1与子动脉之间角度的总和（BifA）。
结果
本研究共纳入163例符合纳入标准的患者：ICAbifAn组58例患者，非ICAbifAn组105例患者。单因素逻辑回归分析显示，P1、BifSR、α和BifA测量值是动脉瘤形成的显著预测因素。然而，多因素分析后，只有BifA角保留了其显著性（OR，0.911（0.877 - 0.946），P < 0.001）。在ROC曲线中，准确区分ICAbifAn和非动脉瘤性分叉的最佳BifA阈值为210°（曲线下面积（AUC），0.81；敏感性，69%；特异性，87%）。α角的AUC为0.68。
结论
这些结果表明，分叉几何形状在动脉瘤形成的可能性中起重要作用。我们还表明，BifA比α角更能预测动脉瘤的形成。
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