未破裂颅内动脉瘤筛查和治疗进展

Advance on screening and intervention of unruptured intracranial aneurysm

未破裂颅内动脉瘤(IA)作为一种致命性脑血管疾病,目前得到越来越多的重视。最新研究进展表明,IA的筛查需要综合动脉瘤患病率、发病率、检测成本、社会因素等进行综合评估,对于存在流行病高危因素的患者,建议尽早启动筛查流程。数字减影血管造影虽然是目前诊断动脉瘤的金标准,但是CT血管造影(CTA)和MR血管成像(MRA)在某些方面同样具有明显优势。CTA被视为用于动脉瘤检测和筛查的首选无创检查手段,而MRA在一些特殊情况下也可作为首选检查方法。未破裂IA破裂风险的评估是决定后续干预措施的基本前提,在目前较为复杂且困难,需要更进一步的研究明确。常规临床指标、血流动力学参数以及更新的瘤壁成像技术等,可以从生理及病理的角度提高临床医生对IA破裂风险评估的准确性。未破裂IA的治疗决策应当综合IA的临床指标、流行病学因素以及患者心理状态等多种因素权衡考虑,在动脉瘤直径这个因素上还需要注意东西方人群的差异。对于需要手术干预的患者应严格把握指征,对于暂不需要手术的患者应进行常规影像学检查随访。

Unruptured intracranial aneurysm has received more and more attention as a fatal cerebrovascular disease.The latest research shows that the screening of intracranial aneurysms requires a comprehensive assessment including the morbidity,mortality,costs,and social factors.For patients with high-risk factors of the epidemic,it is recommended to start screening as soon as possible.Although DSA is still the golden standard for diagnosing aneurysm,CTA and MRA also have obvious advantages in some aspects.CTA can be regarded as the preferred noninvasive method for aneurysm detection and screening,and MRA can also be the first choice in some special cases.The assessment of the rupture risk of unruptured intracranial aneurysms is the fundamental of further interventions.Currently,it is complex and difficult,and further research is needed.Clinical parameters,hemodynamic parameters,and aneurysm wall imaging techniques can increase the accuracy of rupture risk from a pathophysiological perspective.The treatment decision of unruptured aneurysm should be in consideration of clinical index of aneurysm,epidemiological factors of patients,and social/psychological factors.The aneurysm diameter should also be pay attention to the ethnic differences between East and West.For patients who need surgical intervention,the indications should be strictly followed,and routine imaging follow-up should be performed for those who do not need surgery temporarily.