Morphological predictors of posterior communicating artery aneurysms rupture

Objective: The conflicting findings of previous morphological studies on intracranial aneurysm rupture may be caused by the different locations of aneurysms. We aimed to determine the independent risk factors of aneurysm rupture by focusing on only posterior communicating artery(Pcom A) aneurysms. Methods: In 89 PcomA aneurysms(58 ruptured, 31 unruptured), clinical and morphological characteristics were compared between the ruptured and unruptured groups. Multivariate logistic regression analysis was performed to determine the independent predictors for the rupture status of PcomA aneurysms. Results: In univariate analyses, the aneurysm dome size, aspect ratio, size ratio,dome‐to‐neck ratio, and inflow angle were significant parameters. With multivariate analyses, only the aneurysm dome size and inflow angle were significantly associated with the rupture status of PcomA aneurysms. Conclusions: Morphology was related with rupture of PcomA aneurysms. The aneurysm dome size and inflow angle were found to be the independent parameters characterizing the rupture status of PcomA aneurysms.

介入栓塞术与开颅夹闭术治疗后交通破裂动脉瘤的疗效与安全性比较

目的分析介入栓塞术和开颅夹闭术治疗后交通破裂动脉瘤的疗效与安全性。方法 80例后交通破裂动脉瘤患者,根据治疗方法的不同分为栓塞组和夹闭组,各40例。栓塞组行介入栓塞术治疗,其中22例采用单纯弹簧圈治疗,设为弹簧圈组;18例采用支架辅助弹簧圈治疗,设为支架组。夹闭组行开颅夹闭术治疗。对比栓塞组和夹闭组并发症发生情况,对比栓塞组中支架组、弹簧圈组与夹闭组病死率、复发率、术后1个月及6个月改良Rankin量表(mRS)评分。结果栓塞组并发症发生率5.00%低于夹闭组的25.00%,差异具有统计学意义(P<0.05)。支架组、弹簧圈组、夹闭组病死率分别为5.56%、4.55%、2.50%,支架组、弹簧圈组、夹闭组病死率组间两两比较,差异均无统计学意义(P>0.05);支架组、弹簧圈组、夹闭组复发率分别为0、27.27%、10.00%,支架组与夹闭组、弹簧圈组与夹闭组复发率比较,差异均无统计学意义(P>0.05);支架组复发率低于弹簧圈组,差异具有统计学意义(P<0.05)。支架组、弹簧圈组、夹闭组术后1个月mRS评分0~2分比例分别为88.89%、81.82%、87.50%,术后6个月mRS评分0~2分比例分别为88.89%、90.91%、92.50%,支架组、弹簧圈组、夹闭组术后1个月及6个月m RS评分0~2分比例组间两两比较,差异均无统计学意义(P>0.05)。结论介入栓塞术与开颅夹闭术在后交通破裂动脉瘤治疗中均有良好疗效,前者并发症发生率较低,但前者中单纯弹簧圈栓塞的复发率偏高,两种术式在近期和远期预后上无显著差异。

球囊辅助弹簧圈栓塞治疗老年破裂宽颈后交通动脉瘤29例临床分析

目的探讨球囊辅助弹簧圈栓塞治疗老年破裂宽颈后交通动脉瘤的有效性和安全性。方法河北医科大学第二医院神经外科自2016年9月至2017年12月应用球囊辅助弹簧圈栓塞治疗老年破裂宽颈后交通动脉瘤患者29例,其中入院时改良Rankin量表(mRS)评分0~2分18例,3分7例,4分4例;Hunt-Hess分级Ⅰ~Ⅱ级21例,Ⅲ~Ⅳ级8例。回顾性分析患者的临床资料和疗效。结果28例患者成功进行球囊辅助弹簧圈栓塞动脉瘤,1例患者动脉瘤颈过宽,释放球囊后弹簧圈框架结构不稳定,改为支架辅助栓塞。术后即刻栓塞效果:Raymond分级1级25例,2级4例。患者出院时mRS评分0~2分24例,3分2例,4分1例,死亡2例(分别死于重症肺炎合并糖尿病酮症酸中毒和突发心脏事件)。发生与手术相关并发症3例,包括术中动脉瘤破裂1例,一侧肢体无力1例,对侧肢体瘫痪1例,经治疗后均恢复。结论球囊辅助弹簧圈栓塞治疗老年破裂宽颈后交通动脉瘤安全、有效。