前交通动脉瘤破裂的血管和动脉瘤形态学危险因素分析

Risk Factor Analysis of Vascular and Aneurysm Morphology for Ruptured Anterior Communicating Artery Aneurysm

目的探讨前交通动脉瘤(anterior communicating artery aneurysm,ACoA)破裂的血管和动脉瘤形态学危险因素。方法回顾性收集2016年6月~2022年12月徐州医科大学附属医院收治的211例ACoA患者,按其是否破裂分为破裂组(n=149)和未破裂组(n=62),收集患者的一般资料,测量大脑前动脉分叉角度、动脉瘤形态学参数和优势侧大脑中动脉(middle cerebral artery,MCA)始段、大脑前动脉A1始段和颈内动脉(internal carotid artery,ICA)末端的直径及A1/ICA夹角。采用多因素Logistic回归分析评价ACoA破裂的危险因素,采用Spearman秩相关分析评价大脑前动脉A1始段、MCA始段、ICA末端的直径和A1/ICA角与ACoA破裂的关系。结果年龄、高血压、高宽比(aspect ratio,AR)、瘤体不规则、A1段变异、A2/前交通动脉(anterior communicating artery,Acom)角、入射角是影响ACoA破裂的危险因素。A1/ICA角与ACoA破裂呈正相关,而MCA始段直径与ACoA破裂呈负相关。结论除了年龄、高血压、AR、瘤体不规则是ACoA破裂的危险因素外,A1段变异、A2/Acom角、入射角等血管形态学对ACoA破裂具有一定的预测作用。此外,当A1段发生变异,优势侧A1/ICA角越大,MCA始段直径越小,ACoA越容易破裂。

Objective To investigate the risk factors of vascular and aneurysm morphological for rupture of anterior communicating artery aneurysm(ACoA).Methods A total of 211 patients with ACoA admitted to the Affiliated Hospital of Xuzhou Medical University from June 2016 to December 2022 were retrospectively collected,and they were divided into ruptured group(n=149)and unruptured group(n=62)according to whether they were ruptured or not.The general data of the patients were collected,the bifurcation angle of the anterior cerebral artery,the morphological parameters of the aneurysm,the diameters of the beginning segment of the dominant side middle cerebral artery(MCA)and the beginning segment of anterior cerebral artery A1 and the end of the internal carotid artery(ICA),the A1/ICA angle were measured.Multivariate Logistic regression analysis was used to analyze the risk factors of ACoA rupture,and Spearman rank correlation analysis was used to analyze the relationship between the diameters of the beginning segment of the dominant side MCA,the diameters of the beginning segment of anterior cerebral artery A1,the diameters of the end segment of ICA,the A1/ICA angle and ACoA rupture.Results Age,hypertension,aspect ratio(AR),aneurysm irregularity,variation of A1 segment,A2/anterior communicating artery(Acom)angle,and flow angle were risk factors affecting ACoA rupture.The A1/ICA angle was positively correlated with ACoA rupture,whereas the diameter of the beginning of the MCA was negatively correlated with ACoA rupture.Conclusion In addition to age,hypertension,AR,and aneurysm irregularity as risk factors for aneurysm rupture,vascular morphology such as A1segment variation,A2/Acom angle,and flow angle have a certain predictive effect on aneurysm rupture.In addition,when A1segment mutates,the larger the A1/ICA angle on the dominant side,the smaller the diameter of the beginning segment of the MCA,and the easier the rupture of the ACoA.