Lan Chuanjin, Zhang Jiaming, Liu Qingyuan, Wang Shuo
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Neurosurg Rev. 2025 Jul 31;48(1):584. doi: 10.1007/s10143-025-03722-8.
Aneurysm location is strongly related to the risk of aneurysm growth and rupture. Due to the unique anatomic features of internal carotid artery (ICA), unruptured intracranial aneurysms (UIAs) located in different segments of ICA may exhibit distinct instability risks. However, the natural instability risk of UIAs across ICA segments has not been extensively studied. This study included patients with ICA UIAs from two prospective, multicenter Chinese cohorts. All patients underwent regular follow-up for at least four years. The primary outcome was aneurysm instability (rupture, growth, and morphological change). ICA segments were classified per Bouthillier's. C7 bifurcation (Bifur), posterior communicating artery (Pcom), and others. The 4-year instability risk was analyzed by segment. Cox regression identified factors associated with instability. This study included 779 patients. During 3153 aneurysm-years of follow-up, aneurysm instability occurred in 21/29 (incidence rate [IR]: 25.94%; 95%CI, 15.63-36.26%) UIAs in the C7-Pcom, 18/62 (IR: 10.64%; 95%CI, 6.34-14.94%) UIAs in the C7-Bifur, 28/688 (IR: 0.97%; 95%CI, 0.61-1.32%) UIAs in other segments of ICAs. Multivariable analysis showed that UIAs located in the C7-Pcom(hazard ratio, 9.76; 95%CI, 5.39-17.67) and in the C7-Bifur (hazard ratio, 15.79; 95%CI, 8.54-29.19) were associated with instability of ICA UIAs. UIAs in the C7-Bifur/Pcom have substantially higher instability risks than those in other ICA segments. The precise anatomic location should be prioritized in risk evaluation.
动脉瘤的位置与动脉瘤生长和破裂的风险密切相关。由于颈内动脉（ICA）独特的解剖学特征，位于ICA不同节段的未破裂颅内动脉瘤（UIAs）可能表现出不同的不稳定风险。然而，ICA各节段UIAs的自然不稳定风险尚未得到广泛研究。本研究纳入了来自两个前瞻性、多中心中国队列的ICA UIAs患者。所有患者均接受了至少四年的定期随访。主要结局是动脉瘤不稳定（破裂、生长和形态改变）。ICA节段根据布蒂利耶分类法进行分类。C7分叉处（Bifur）、后交通动脉（Pcom）以及其他节段。按节段分析4年的不稳定风险。Cox回归确定与不稳定相关的因素。本研究纳入了779例患者。在3153个动脉瘤年的随访期间，C7 - Pcom节段的21/29例UIAs（发病率[IR]：25.94%；95%CI，15.63 - 36.26%）出现动脉瘤不稳定，C7 - Bifur节段的18/62例UIAs（IR：10.64%；95%CI，6.34 - 14.94%）出现动脉瘤不稳定，ICA其他节段的28/688例UIAs（IR：0.97%；95%CI，0.61 - 1.32%）出现动脉瘤不稳定。多变量分析显示，位于C7 - Pcom节段（风险比，9.76；95%CI，5.39 - 17.67）和C7 - Bifur节段（风险比，15.79；95%CI，8.54 - 29.19）的UIAs与ICA UIAs的不稳定相关。C7 - Bifur/Pcom节段的UIAs比ICA其他节段的UIAs具有更高的不稳定风险。在风险评估中应优先考虑精确的解剖位置。
