前交通动脉瘤破裂的临床和放射解剖学危险因素

Clinical and radio-anatomical risk factors for the rupture of anterior communicating artery aneurysms

目的探讨前交通动脉瘤(ACoAA)破裂的临床和放射解剖学危险因素。方法从前瞻性建立的脑动脉瘤数据库中收集2008年6月至2013年6月经CTA、MRA和(或)DSA确诊的ACoAA患者。根据动脉瘤状态,入选患者分成ACoAA破裂组和未破裂组。收集动脉瘤破裂可能的临床和放射解剖学危险因素,并作单因素和多变量Logistic回归分析。结果 251例ACoAA患者入选研究,其中131例为ACoAA破裂患者。单因素分析显示破裂组患者年龄明显小于未破裂组(P<0.01),<60岁患者和伴有高血压患者比例远高于未破裂组;破裂组动脉瘤平均最大直径大于未破裂组(P<0.01),最大直径≥3 mm比例远高于未破裂组;破裂组大脑前动脉A1段发育不对称(缺如、发育不良)比例远高于未破裂组。多变量Logistic回归分析显示年龄<60岁、高血压病史、动脉瘤最大直径≥3 mm和大脑前动脉A1段发育不良或缺如是ACoAA破裂独立危险因素。结论年龄<60岁、高血压病史、动脉瘤最大直径≥3 mm和大脑前动脉A1段发育不良或缺如是ACoAA破裂独立危险因素,可作为未破裂ACoAA是否积极干预的重要参考依据。

Objective To identify the clinical and radio-anatomical risk factors for the rupture of anterior communicating artery aneurysm （ACoAA）. Methods Patients with ACoAAs, which were confirmed by CTA, MRA and/or DSA in the period from June 2008 to June 2003, were collected from prospectively established cerebral aneurysm database. According to the state of aneurysm, the selected patients were divided into ACoAA rupture group and non-rupture group. The possible clinical and radio-anatomical risk factors for the rupture of ACoAA were analyzed by using univariate and multivariate logistic regression methods. Results A total of 251 patients with ACoAA were enrolled in this study; among them, 131 patients had ruptured ACoAA. Univariate analysis showed that the patient＇s age of rupture group was significantly lower than that of non-rupture group （P〈0.01）, and in the rupture group the proportion of patients 〈60 years old and the proportion of patients with hypertension were also significantly higher than those in the non-rupture group. In the rupture group, the average maximum diameter of ACoAA was significantly larger than that in the non-rupture group （P〈0.01）, and the proportion of maximum diameter ≥ 3 mm ACoAA was much higher than that in the non- rupture group. In the rupture group, the proportion of developmental asymmetry of A1 segment of anterior cerebral artery （i.e. aplasia or dysplasia） was strikingly higher than that in the non-rupture group. Multivariate logistic regression analysis revealed that patient＇s age 〈60 years old, history of hypertension, maximum diameter of aneurysm Qjkg-〉3 nun and presence of hypoplasia or aplasia of A1 of anterior cerebral artery were independent risk factors for the rupture of ACoAA. Conclusion Patient＇s age 〈 60 years old, history of hypertension, maximum diameter of aneurysm≥3 mm and presence of hypoplasia or aplasia of Al of anterior cerebral artery are independent risk factors for the rupture of ACoAA. These factors can be used as important reference indexes in making therapeutic plan for un-ruptured ACoAA. （J Intervent Radiol, 2016, 25： 562-567）