Aneurysms at nonbranching sites in the supraclinoid portion of the internal carotid artery: Internal carotid artery trunk aneurysms
Aneurysms at nonbranching sites in the supraclinoid portion of the internal carotid artery: Internal carotid artery trunk aneurysms
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DOI：
10.1097/00006123-200009000-00008
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发表时间：
2000-09-01
期刊：
影响因子：
4.8
通讯作者：
Ogasawara, K
中科院分区：
文献类型：
--
作者：
Ogawa, A;Suzuki, M;Ogasawara, K
目的：位于颈内动脉床上非分支部位的动脉瘤，又称血泡样动脉瘤或颈内动脉前壁或背壁动脉瘤，目前尚不清楚。为了阐明这一临床实体，我们分析了5年间收治的7408例蛛网膜下腔出血患者。方法：48例患者的动脉瘤均经手术证实位于颈内动脉床上段的非分支部位。结果：动脉瘤分为“水泡型”动脉瘤和“囊状型”动脉瘤，前者呈血泡样形态，管壁脆弱；后者呈囊状结构，瘤颈相对坚固，与普通浆果状动脉瘤相似。这两种类型最常见的起源都是前内侧壁。颈内动脉夹层仅与水泡型相关，高血压与水泡型相关(P=0.0978)。这些患者的术前情况相同，但由于动脉瘤内和术后出血频繁，泡沫型动脉瘤患者的预后较差。安全夹闭囊状动脉瘤。夹闭材料治疗泡沫型动脉瘤效果较好，但颈内动脉夹闭(P=0.0952)、夹闭(P=0.0146)和包裹术(P=0.0110)效果较差。结论：泡沫型和囊状动脉瘤具有不同的形态和管壁特征。囊状型可以通过剪裁来治疗，而水泡型则需要在包裹材料上进行剪裁。ICA主干动脉瘤可能是表达这些动脉瘤多样性的更好的名称，而不是ICA血泡样动脉瘤或前壁或背壁动脉瘤。
OBJECTIVE: Aneurysms at nonbranching sites in the supraclinoid internal carotid artery (ICA), known as blood blister-like aneurysms or ICA anterior or dorsal wall aneurysms, are not well understood. To clarify this clinical entity, 7408 patients with subarachnoid hemorrhage who were treated during a 5-year period were analyzed.METHODS: Forty-eight patients had aneurysms that were intraoperatively confirmed to be located at a nonbranching site in the supraclinoid portion of the ICA. Neuroradiological and clinicopathological features and outcomes were studied.RESULTS: The aneurysms were divided into the "blister type," with a blood blister-like configuration and fragile walls, and the "saccular type," with a saccular configuration and a relatively firm neck, like ordinary berry aneurysms. The most frequent origin was the anteromedial wall for both types. ICA dissection was associated only with the blister type, and hypertension was more frequent with the blister type (P = 0.0978). The preoperative conditions of the patients were the same, but the outcomes for patients with blister-type aneurysms were worse, because of frequent intra- and postoperative aneurysmal bleeding. Saccular-type aneurysms were safely clipped. Treatment of blister-type aneurysms by clipping on wrapping material achieved good results, but ICA trapping (P = 0.0952), clipping (P = 0.0146), and wrapping (P = 0.0110) were associated with much worse results.CONCLUSION: Blister-type and saccular-type aneurysms have different shapes and wall characteristics. The saccular type can be treated by clipping, whereas the blister type requires clipping on wrapping material. ICA trunk aneurysms may be a better designation to express the diversity of these aneurysms, rather than ICA blood blister-like or anterior or dorsal wall aneurysms.