脉络膜前动脉瘤破裂的形态学和血流动力学特征分析

Preliminary analysis of morphological and hemodynamic factors affecting rupture of anterior choroidal artery aneurysms

目的 分析脉络膜前动脉瘤破裂的形态学及血流动力学特征。方法 回顾性连续纳入2017年6月至2021年12月就诊于海军军医大学第一附属医院脑血管病中心的脉络膜前动脉瘤患者31例,根据动脉瘤破裂与否,将31例患者分为破裂组(10例)与未破裂组(21例)。记录患者的人口学、临床基线资料以及脉络膜前动脉瘤形态学、血流动力学参数,人口学和临床基线资料包括年龄、体质量指数、性别、高血压病史、糖尿病史、高脂血症、吸烟史、饮酒史、家族史、蛛网膜下腔出血史、合并其他动脉瘤;脉络膜前动脉瘤形态学参数包括动脉瘤大小、垂直高度、中部直径、载瘤动脉直径、载瘤动脉角度、动脉瘤入射角、纵横比、尺寸比、瓶颈比、凸包表面积、凸包体积、动脉瘤体积、动脉瘤表面积、波动指数、椭圆形指数、非球面指数、子囊;血流动力学参数包括动脉瘤平均流速、平均壁面剪应力、标准化壁面剪应力、震荡剪切指数及载瘤动脉壁面剪应力。比较两组间的基线资料、形态学参数和血流动力学参数,分析脉络膜前动脉瘤破裂的形态学及血流动力学特征。结果 (1)破裂组与未破裂组年龄、体质量指数、性别、高血压病史、糖尿病史、高脂血症、吸烟史、饮酒史、家族史、蛛网膜下腔出血史、合并其他动脉瘤的差异均无统计学意义(均P>0.05)。(2)破裂组动脉瘤的纵横比、椭圆形指数、非球面指数、伴有子囊占比均大于未破裂组,组间差异均有统计学意义[1.47(0.89,1.72)比0.82(0.65,1.16),Z=-2.24,P=0.03;0.18(0.08,0.30)比0.10(0.04,0.16),Z=-1.98,P=0.04;0.21(0.10,0.34)比0.11(0.05,0.19),Z=-2.11,P=0.03;5/10比1/21,P=0.01];余形态学参数组间差异均无统计学意义(均P>0.05)。(3)血流动力学参数组间差异均无统计学意义(均P>0.05)。结论 破裂脉络膜前动脉瘤具有高纵横比、高椭圆形指数、高非球面指数、高子囊占比的特征,能否作为脉络膜前动脉瘤破裂的危险因素仍需进一步研究。

Objective To analyze the morphological and hemodynamic factors affecting the rupture of anterior choroidal artery(AchA) aneurysms.Methods Thirty-one patients with DSA-confirmed AchA aneurysm and admitted to the Neurovascular Center,First Hospital Affiliated to the Naval Military Medical University from June 2017 to December 2021 were retrospectively included.According rupture or not,the patients were divided into the ruptured group(10 cases) and unruptured group(21 cases).The clinical baseline,morphological and hemodynamic parameters of AchA aneurysms were recorded.The demographic and clinical baseline,morphological and hemodynamic parameters of AchA aneurysms were recorded.The demographic and clinical baseline included age,body mass index,gender,hypertension,diabetes,hyperlipidemia,smoking,drinking,family history,history of subarachnoid hemorrhage,and aneurysms in other location.The morphological parameters of AchA aneurysms included aneurysm size,vertical height,middle diameter,current parent artery diameter,current parent artery angle,aneurysm incidence angle,aspect ratio(AR),size ratio,bottle neck ratio,convex hull surface area,convex hull volume,aneurysm volume,aneurysm surface area,undulation index,ellipticity index(EI),non sphericity index(NSI) and bleb formation.Hemodynamics parameters include average velocity,average wall shear stress,normalized wall shear stress,oscillatory shear index of aneurysm and the parent artery wall shear stress.The baseline data,morphological parameters and hemodynamic parameters were compared between the ruptured and unruptured groups,and the morphological and hemodynamic characteristics of ruptured anterior choroidal aneurysms were analyzed.Results(1) There was no significant difference in age,body mass index,gender,history of hypertension,history of diabetes,hyperlipidemia,smoking,drinking,family history,history of subarachnoid hemorrhage and other aneurysms between the ruptured group and the unruptured group(all P>0.05).(2) Among the morphological parameters of AchA aneurysm,the AR,EI,NSI,and the proportion of aneurysms with bleb formation in the ruptured group were greater than those in the unruptured group,and the differences were statistically significant(1.47[0.89,1.72] vs 0.82 [0.65,1.16],Z=-2.24,P=0.03;0.18 [0.08,0.30] vs 0.10 [0.04,0.16],Z=-1.98,P=0.04;0.21 [0.10,0.34] vs 0.11[0.05,0.19],Z=-2.11,P=0.03;5/10 vs 1/21,P=0.01);there was no significant difference in other morphological parameters between two groups(all P>0.05).(3) There was no significant difference in hemodynamic parameters between groups(all P> 0.05).Conclusions Ruptured AchA aneurysms have the characteristics of high AR,high EI,high NSI,and high ratio of bleb formation.Whether they can be used as risk factors for AchA aneurysms rupture still needs to be further studied.