大脑前动脉A1段发育不良和分叉角度与前交通动脉瘤形成的相关性

Association between A1 segment dysplasia,bifurcation angles of anterior cerebral artery and the formation of anterior communicating aneurysms

目的研究大脑前动脉A1段发育不良和分叉角度与前交通动脉瘤形成的关系。方法收集东部战区总医院2010年1月至2017年3月期间同时接受颅脑计算机断层扫描血管成像(computed tomography angiography,CTA)和数字减影血管造影(digital subtraction angiography,DSA)或手术确诊的272例前交通动脉瘤(anterior communicating aneurysm,ACoA)患者以及272例年龄和性别匹配的正常对照组。评估所有研究对象A1段发育情况,分为正常、发育不良和缺如,并分别测量大脑前动脉分叉角度,包括A1段与前交通动脉(anterior communicating artery,Acom)之间(A1/Acom)、A2段与Acom之间(A2/Acom)以及A1与A2段之间(A1/A2)的夹角。结果所有患者平均年龄(54±11)岁,女性占55.15%。动脉瘤发生在前交通动脉左分叉部193例(70.96%),发生在右分叉部79例(29.04%)。252例(92.65%)前交通动脉瘤破裂,中位最大径为4.54(3.64,6.01)mm。动脉瘤组中A1段发育不良或缺如患者229例(84.19%),其中位于动脉瘤对侧的病例223例(81.99%),而患侧A1段发育不良的病例6例(2.21%)。对照组中A1段发育不良或缺如的患者126例(46.32%)。动脉瘤组A1段发育不良或缺如的比例(84.19%)明显高于对照组(46.32%)(P<0.001)。动脉瘤组患侧A2/Acom角度[125.01(108.89,144.55)°]大于对照组[101.44(91.30,115.17)°],A1/A2角度(110.01±20.72)°小于对照组(130.28±18.30)°(P<0.001),A1/Acom角度[107.86(93.47,128.18)°]小于对照组[111.99(100.18,126.66)°](P=0.05)。结论前交通动脉瘤的存在与A1段发育不良或缺如(尤其对侧)、较大的A2/Acom分叉角、较小的A1/A2和A1/Acom分叉角相关,且A1段发育不良或缺如及A2/Acom分叉角是前交通动脉瘤形成的独立风险预测因子。

Objective To investigate the relationship between the dysplasia and bifurcation angles of A1 segment of the anterior cerebral artery(ACA)and the formation of the anterior communicating aneurysms(ACoA).Methods Totally 272 patients with anterior communicating artery(Acom)bifurcation aneurysms who underwent CT angiography(CTA)and digital subtraction angiography(DSA)or clipping surgery(aneurysm group)and 272 age and sex matched subjects(control group)were retrospectively collected in Jinling Hospital,Nanjing,China between Jan.2010 and Mar.2017.A1 segment of ACA was assessed by an experienced radiologist in the aneurysm group and normal group as symmetric,hypoplasia,and absence,as well as ACA bifurcation angles.The angles between the A1 or A2 segment and Acom(A1/Acom,A2/Acom)and between the A1 and A2 segments(A1/A2)were measured.Results The mean age of all patients was(54±11)years and 55.15%subjects were female.In the aneurysm group,70.96%of aneurysms were in the left Acom bifurcation,and 29.04%in the right.The median size was 4.54(3.64,6.01)mm.229 cases(84.19%)had A1 segment hypoplasia or absence in aneurysm group,of which 223 cases(81.99%)were contralateral,6 cases(2.21%)were ipsilateral.In the control group,126 cases(46.32%)had A1 segment hypoplasia or absence.A1 segment hypoplasia or absence in the aneurysm group(84.19%)was higher than that in the control group(46.32%)(P<0.001).The A2/Acom angle[125.01(108.89,144.55)°]in the aneurysm group was higher than that in the control group[101.44(91.30,115.17)°],and the A1/A2 angle(110.01±20.72)°was lower than that in the control group(130.28±18.30)°(P<0.001),and the A1/Acom angle[107.86(93.47,128.18)°]was lower than that in the control group[111.99(100.18,126.66)°](P=0.05).Conclusions The presence of ACoA is associated with hyposplasia or absence of A1 segment(especially contralateral),larger A2/Acom and smaller A1/A2 and A1/Acom angles of the ACA bifurcation,and A1 segment hypoplasia or absence and the A2/Acom bifurcation angle were independent risk factors for AcoA formation.