Anatomic Risk Factors for Middle Cerebral Artery Aneurysm Rupture: Computed Tomography Angiography Study of 1009 Consecutive Patients
Anatomic Risk Factors for Middle Cerebral Artery Aneurysm Rupture: Computed Tomography Angiography Study of 1009 Consecutive Patients
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DOI：
10.1227/neu.0000000000000116
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发表时间：
2013-11-01
期刊：
影响因子：
4.8
通讯作者：
Hernesniemi, Juha
中科院分区：
文献类型：
--
作者：
Elsharkawy, Ahmed;Lehecka, Martin;Hernesniemi, Juha
背景：大脑中动脉(MCA)是未破裂的颅内动脉瘤最常见的部位。对于哪些未破裂的大脑中动脉动脉瘤应该预防性治疗仍存在争议。目的：找出可以预测大脑中动脉破裂风险增加的独立的解剖和形态变量。方法：对2000年至2009年赫尔辛基大学医院收治的1009例1309个大脑中动脉动脉瘤的CT血管成像资料进行回顾性分析。检查MCA动脉瘤的形态和地形学参数，包括瘤壁的规则性、大小、颈宽、长径比、瓶颈因素、高宽比、沿MCA的位置、侧、距颈内动脉分叉处的距离以及轴位和冠状位CT血管成像的穹顶投影。采用单因素和多因素Logistic回归分析确定破裂的独立危险因素。结果：1309个MCA动脉瘤中69%未破裂，31%破裂。大多数未破裂的大脑中动脉动脉瘤直径小于7 mm(78%)，管壁光滑(80%)，高宽比为1(47%)，位于主分叉处(57%)。破裂的大脑中动脉动脉瘤直径多为7~14 mm(55%)，瘤壁不规则(78%)，高宽比大于1(72%)，位于主分叉处(77%)。38%的大脑中动脉分叉部动脉瘤、74%的大型动脉瘤、%的不规则壁动脉瘤和49%的高宽比大于1的动脉瘤破裂。结论：大脑中动脉主干分叉处的位置、管壁不规则、球状结构与大脑中动脉动脉瘤破裂独立相关，且与动脉瘤大小有关。
BACKGROUND: The middle cerebral artery (MCA) is the most frequent location for unruptured intracranial aneurysms. Controversy remains as to which unruptured MCA aneurysms should be treated prophylactically.OBJECTIVE: To identify independent topographical and morphological variables that could predict increased rupture risk of MCA aneurysms.METHODS: A retrospective analysis of computed tomography angiography data of 1009 consecutive patients with 1309 MCA aneurysms, referred between 2000 and 2009 to Helsinki University Hospital, was carried out. Morphological and topographical parameters examined for MCA aneurysms comprised aneurysm wall regularity, size, neck width, aspect ratio, bottleneck factor, height-width ratio, location along the MCA, side, distance from the internal carotid artery bifurcation, and dome projection in axial and coronal computed tomography angiography views. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors for rupture.RESULTS: Of the 1309 MCA aneurysms, 69% were unruptured and 31% were ruptured. Most unruptured MCA aneurysms were smaller than 7 mm (78%), with a smooth wall (80%) and a height-width ratio of 1 (47%) and were located at the main bifurcation (57%). Ruptured MCA aneurysms, mostly 7 to 14 mm in size (55%), had an irregular wall (78%) and a height-width ratio greater than 1 (72%) and were located at the main bifurcation (77%). Thirty-eight percent of MCA bifurcation aneurysms, 74% of large aneurysms, 64% of aneurysms with an irregular wall, and 49% of aneurysms with a height-width ratio greater than 1 were ruptured.CONCLUSION: Location at the main MCA bifurcation, wall irregularity, and less spherical geometry were independently associated with rupture of MCA aneurysms with a correlation with aneurysm size.