前交通动脉瘤形成和大脑前动脉分叉的几何形态学相关性研究

Correlation between anterior communicating artery aneurysm formation and anterior cerebral artery bifurcation geometry

目的:大脑前交通(Anterior communicating artery,Acom)动脉瘤是脑动脉瘤中最复杂的一种,较大的分叉顶角往往伴随着动脉瘤的形成。在本研究中,我们旨在考察Acom动脉瘤的形成与大脑前动脉(Anterior cerebral artery,ACA)分叉角度、分叉血管直径之间的相关性。方法:698例患者的数字减影血管造影(Digital subtraction angiography,DSA)用于本研究,包括171例Acom动脉瘤患者和527例无瘤患者。我们测量了ACA分叉角度、分叉血管直径和动脉瘤的最大高度、宽度。结果:随着年龄的增长,ACA分叉顶角(Acom/A2)的角度显著增加(P<0.000 1),而Acom/A1和A1/A2角度显著降低(分别为P=0.000 2和P<0.000 1)。Acom动脉瘤组的Acom/A2角度显著大于正常对照组,但是A1/A2、Acom/A1角度显著小于对照组(分别为P<0.0001和P=0.003 7)。并且,Acom、ACA的血管直径、动脉瘤瘤颈与动脉瘤的大小间存在显著正相关性(均为P<0.000 1)。结论:Acom动脉瘤患者具有较大的Acom/A2角度,分支血管直径与动脉瘤的体积具有显著正相关性。

Objective: The anterior communicating artery(Acom) aneurysm is considered the most complex in all cerebral aneurysms, and the relationship between the Acom morphology parameters and the Acom aneurysm formation is not clear. In this study, we aimed to determine the relationship of bifurcation angle, anterior cerebral artery(ACA) and Acom diameters associated with Acom aneurysm. Methods: The digital substraction angiography(DSA) of 698 patients was used in this study, including 171 patients with Acom aneurysm and 527 control subjects. The Acom/A2 angle, artery diameter and Acom aneurysm geometric characteristics were examined. Results: With aging, the apex angle of ACA-Acom bifurcation(Acom/A2) angle, was significantly increased(P<0.000 1). Conversely, the Acom/A1 and A1/A2 angles were significant decreased(P=0.000 2 and P<0.000 1, respectively). The Acom/A2 angle was significantly wider in patients with Acom aneurysm than in the controls(P <0.000 1), whereas A1/A2 and Acom/A1 angles in the aneurysm group were significantly smaller than in the control group(P<0.000 1 and P=0.003 7, respectively). Furthermore, a statistical positive correlation between the Acom, A1/A2 segment of ACA diameter and aneurysm geometric size(P<0.000 1), and aneurysm neck was observed(P<0.000 1). Conclusion: Acom aneurysms are associated with the wider Acom/A2 angle junction of the Acom complex, and bifurcation artery diameter shows a significant positive correction with aneurysm size.