颅内动脉瘤患者颈内动脉虹吸部解剖特点及其与动脉瘤破裂的关联性研究

Study on the relationship between the anatomical features of internal carotid siphon and aneurysm ruptures in patients with intracranial aneurysms

目的探讨颅内动脉瘤患者颈内动脉虹吸部解剖特点及其与动脉瘤破裂的关联性。方法回顾性分析2019年10月至2021年11月天津市环湖医院收治的172例颅内动脉瘤患者的病历资料,根据患者动脉瘤破裂情况将其分为破裂组(67例)和未破裂组(105例)。比较两组一般临床资料、动脉瘤的形态和位置,以及动脉瘤测量指标和颅内动脉瘤所在侧的颈内动脉虹吸部的测量指标。结果两组年龄、性别、高血压史、糖尿病史、吸烟史、饮酒史比较差异均无统计学意义(P>0.05)。破裂组动脉瘤形态不规则的比例显著高于未破裂组(47.76%vs 8.57%,P<0.05)。破裂组颈内动脉虹吸部的前弯角和前上弯角大于未破裂组,差异有统计学意义(P<0.05)。二元多因素logistic回归分析结果显示,动脉瘤形态不规则(OR=5.722)和较大的颈内动脉虹吸部前弯角(OR=1.195)是促进动脉瘤发生破裂的危险因素(P<0.05)。ROC曲线分析结果显示,颈内动脉虹吸部前弯角>29.38°时提示颅内动脉瘤发生破裂的可能性显著增大。结论颅内动脉瘤形态不规则和颈内动脉虹吸部前弯角增大是颅内动脉瘤破裂的独立危险因素,临床医师应注意高危患者的筛查,及时予以干预。

Objective To investigate the anatomical features of internal carotid siphon in patients with intracranial aneurysms and their associations with aneurysm ruptures.Methods A retrospective analysis was performed on 172 patients with intracranial aneurysms who were admitted to Tianjin Huanhu Hospital from October 2019 to November 2021,and theywere divided into a ruptured group(67 cases)and an unruptured group(105 cases)according to their aneurysm ruptures.The general clinical data,the morphology and location of aneurysms,as well as the measurement indicators of aneurysms and the measurement indicators of the internal carotid siphon on the side of intracranial aneurysms were compared between the two groups.Results There were no significant differences in age,gender,history of hypertension,diabetes,smoking and alcohol drinking between the two groups(P>0.05).The proportion of irregular aneurysm morphology in the ruptured group was significantly higher than that in the unruptured group(47.76%vs 8.57%,P<0.05).The anterior bend angle and the anterosuperior bend angle of the internal carotid siphon in the ruptured group were larger than those in the unruptured group,and the differences were statistically significant(P<0.05).The results of binary logistic regression analysis showed that irregular aneurysm morphology(OR=5.722)and larger anterior bend angle of internal carotid siphon(OR=1.195)were the risk factors to promote aneurysm ruptures(P<0.05).The results of receiver operating characteristic(ROC)curve analysis showed that the likelihood of intracranial aneurysms rupturing[LM]increased significantly if the anterior bend angle of the internal carotid siphon was larger than 29.38°.Conclusion The intracranial irregular aneurysm morphology and the increase of anterior bend angle of internal carotid siphon are independent risk factors for intracranial aneurysm ruptures.Clinicians should pay attention to the screening of high-risk patients and give them timely intervention.