大脑前动脉A1段优势和前交通动脉瘤相关性研究

Research on the correlation of A1 segment predomination of anterior cerebral artery associated with anterior communicating artery aneurysms

目的对前交通动脉瘤患者的全脑血管造影结果进行回顾,分析大脑前动脉A1段优势征和前交通动脉瘤发生的关系。方法收集我科收治的209例颅内动脉瘤患者,其中66例为前交通动脉瘤,选取143例颅内其他部位动脉瘤患者和随机抽取66例颅内动脉瘤阴性患者的脑血管造影结果作为对照。结果全脑血管造影提示,66例前交通动脉瘤患者中A1段优势征41例(62.1%),其中左侧优势征33例(80.5%),右侧优势征8例(19.5%),左侧的发生率是右侧的4约倍;143例颅内其他部位动脉瘤患者中A1段优势征21例(14.7%);66例颅内动脉瘤阴性患者中A1段优势征18例(27.3%)。结论A1段优势多发生在前交通动脉瘤侧,左侧有侧别优势。A1段优势与前交通动脉瘤发生有密切关系,血流动力学因素在前交通动脉瘤起源、发生乃至破裂中起着重要作用。

Objective On the basis of the cerebral angiographic imaging, this study was undertaken to investigate the correlation between the presence of anterior communicating artery （ACoA） aneurysm and the ipsilateral dominant A1 segment of anterior cerebral artery （ACA）. Methods Two hundred and nine patients harboring saccular aneurysms demonstrated by digital subtraction angiography were collected for study. There were 66 cases with aneurysms of ACoA. The remaining 143 cases were other intracranial aneurysms and another 66 cases free of intracranial aneurysms were randomly drawn as control. Results Cerebral angiography showed that the dominant A1 segment incidence was 62.1% （41/66） in ACoA aneurysm group, 14.7% （21/ 143） in the group with other intracranial aneurysms and 27.3 % （18/66） in the control group. Within patients with ACoA aneurysms, the incidence of the dominant A1 segment was about 4 times higher on the left side than that on the right side. Conclusion Dominant A1 segment of anterior cerebral artery is much more frequently found in patients with ACoA aneurysms. It can be inferred that hemodynamically generated forces at the apex of anterior cerebral artery bifurcation can maybe an important contributing factor in the focal degeneration of the internal elastic membrane leading to ACoA formation.