[1]李元辉,管 生,徐浩文,等.颅内 ≤ 5 mm动脉瘤破裂的危险因素分析[J].介入放射学杂志,2015,(02):97-101.
 LI Yuan hui,GUAN Sheng,XU Hao wen,et al.Analysis of risk factors for the rupture of small intracranial aneurysms[J].journal interventional radiology,2015,(02):97-101.
点击复制

颅内 ≤ 5 mm动脉瘤破裂的危险因素分析 ()

PDF下载中关闭

分享到:

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2015年02期
页码:
97-101
栏目:
神经介入
出版日期:
2015-02-25

文章信息/Info

Title:
Analysis of risk factors for the rupture of small intracranial aneurysms
作者:
李元辉 管 生 徐浩文 郭新宾 权 涛 刘 朝 王子博 李冬冬
Author(s):
LI Yuan hui GUAN Sheng XU Hao wen GUO Xin bin QUAN Tao LIU Chao WANG Zi bo LI Dong dong.
Department of Neurointervention, First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province 450052, China
关键词:
【关键词】 颅内动脉瘤 破裂 危险因素
文献标志码:
A
摘要:
【摘要】 目的 探讨颅内小动脉瘤破裂的危险因素,为颅内未破裂小动脉瘤干预与否提供依据。方法 收集2010—2013年接受介入治疗、有详细影像资料和临床资料的单发性颅内小动脉瘤(≤ 5 mm)患者180例,其中破裂出血149例,未破裂31例。比较两组患者动脉瘤形态学参数之入射角、动脉瘤瘤体高度与瘤颈长度之比值(AR)、瘤体最大瘤深与近端载瘤动脉直径之比值(SR)、动脉瘤形状、位置和子囊,以及临床危险因素之年龄、性别、高血压、蛛网膜下腔出血史。采用单因素两独立样本t检验(或秩和检验)和卡方检验,以及多变量Logistic回归分析确定两组差异的显著性。结果 单因素分析显示破裂的小动脉瘤多位于前交通动脉(OR = 0.166,P = 0.023)及基底动脉末端(OR = 0.006,P < 0.001),表明前交通部位与基底动脉末端的动脉瘤更易破裂。180例颅内小动脉瘤患者中破裂组与未破裂组动脉瘤部位、子囊、AR值(1.76 ± 0.72对1.35 ± 0.48)、SR值(1.90 ± 0.81对1.31 ± 0.67)、入射夹角(123.9° ± 23.21°对95.96° ± 20.2°)均存在明显的统计学差异(P < 0.05),而两组动脉瘤形态、动脉瘤最大直径以及临床危险因素中年龄、性别、高血压、蛛网膜下腔出血史均无统计学意义(P > 0.05)。多变量Logistic回归分析显示动脉瘤部位(OR = 1.347,P = 0.002)、入射夹角(OR = 1.057,P < 0.001)、SR值(OR = 2.726,P = 0.047)为颅内小动脉瘤破裂的独立危险因素。结论 前交通动脉和基底动脉末端部位、SR值 > 1.90 ± 0.81、入射角度 > 123.9° ± 23.21°为颅内 ≤ 5 mm动脉瘤破裂的独立危险因素,可以作为颅内未破裂小动脉瘤干预与否的参考依据。

参考文献/References:

[1] Wardlaw JM, White PM. The detection and management of unruptured intracranial aneurysms[J]. Brain, 2000, 123: 205 221.
[2] Arimura H, Li Q, Korogi Y, et al. Computerized detection of intracranial aneurysms for three dimensional MR angiography: feature extraction of small protrusions based on a shape based difference image technique[J]. Med Phys, 2006, 33: 394 401.
[3] Ujiie H, Tamano Y, Sasaki K, et al. Is the aspect ratio a reliable index for predicting the rupture of a saccular aneurysm?[J]. Neurosurgery, 2001, 48: 495 503.
[4] Rahman M, Smietana J, Hauck E, et al. Size ratio correlates with intracranial aneurysm rupture status: a prospective study[J]. Stroke, 2010, 41: 916 920.
[5] Baharoglu M, Schirmer CM, Hoit DA, et al. Aneurysm inflow angle as a discriminant for rupture in sidewall cerebral aneurysms: morphometric and computational fluid dynamic analysis[J]. Stroke, 2010, 41: 1423 1430.
[6] Joo SW, Lee SI, Noh SJ, et al. What is the significance of a large number of ruptured aneurysms smaller than 7 mm in diameter?[J]. J Korean Neurosurg Soc, 2009, 45: 85 89.
[7] International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention[J]. N Engl J Med, 1998, 339: 1725 1733.
[8] Wiebers DO, Whisnant JP, Huston J 3rd, et al. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment[J]. Lancet, 2003, 362: 103 110.
[9] Raymond J, Guillemin F, Proust F, et al. A Critical Review of the International Study of Unruptured Intracranial Aneurysms (ISUIA) and of Appropriate Methods to Address the Clinical Problem[J]. Interv Neuroradiol, 2008, 14: 85 96.
[10] Steiner T, Juvela S, Unterberg A, et al. European stroke organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage[J]. Cerebrovasc Dis, 2013, 35: 93 112.
[11] Komotar RJ, Mocco J, Solomon RA. Guidelines for the surgical treatment of unruptured intracranial aneurysms: the first annual J. Lawrence pool memorial research symposium—controversies in the management of cerebral aneurysms[J]. Neurosurgery, 2008, 62: 183 194.
[12] Inagawa T. Risk factors for the formation and rupture of intracranial saccular aneurysms in Shimane, Japan[J]. World Neurusurg, 2010, 73: 155 164.
[13] Nader Sepahi A, Casimiro M, Sen J, et al. Is aspect ratio a reliable predictor of intracranial aneurysm rupture?[J]. Neurosurgery, 2004, 54: 1343 1347.
[14] Zeng Z, Durka MJ, Kallmes DF, et al. Can aspect ratio be used to categorize intra aneurysmal hemodynamics?—A study of elastase induced aneurysms in rabbit[J]. J Biomech, 2011, 44: 2809 2816.
[15] Kashiwazaki D, Kuroda S; Sapporo SAH Study Group. Size ratio can highly predict rupture risk in intracranial small(< 5 mm) aneurysms[J]. Stroke, 2013, 44: 2169 2173.
[16] Tremmel M, Dhar S, Levy EI, et al. Influence of intracranial aneurysm to parent vessel size ratio on hemodynamics and implication for rupture: results from a virtual experimental study[J]. Neurosurgery, 2009, 64: 622 630.
[17] 陆 靖, 李永东, 李明华, 等. 时间飞越法磁共振血管造影对蛛网膜下腔出血诊断和治疗的临床价值[J]. 介入放射学杂志, 2012, 21: 711 717.
[18] 顾斌贤, 李明华, 王 武, 等. 单个弹簧圈栓塞颅内微小动脉瘤的单中心经验[J]. 介入放射学杂志, 2012, 21: 7 13.

相似文献/References:

[1]曹喜才,贺能树,孙建中,等.肾巨大血管平滑肌脂肪瘤破裂无水乙醇栓塞(一例报道)[J].介入放射学杂志,1996,(03):145.
[2]邢 鸣,杨鹏飞,黄清海,等.支架治疗颈内动脉分叉部宽颈动脉瘤[J].介入放射学杂志,2012,(02):92.
 XING Ming,YANG Peng-fei,HUANG Qing-hai,et al.Stent implantation for the treatment of wide-necked aneurysms located at internal carotid artery bifurcation[J].journal interventional radiology,2012,(02):92.
[3]黄海东,顾建文,杨春敏,等.Enterprise支架辅助弹簧圈栓塞治疗前交通宽颈动脉瘤的临床研究[J].介入放射学杂志,2012,(07):536.
 HUANG Hai- dong,GU Jian- wen,YANG Chun-min,et al. Enterprise stent- assisted coil embolization for wide?蛳 necked anterior communicating artery aneurysms: a clinical study[J].journal interventional radiology,2012,(02):536.
[4]陆 靖,李永东,李明华,等. 时间飞越法磁共振血管造影对蛛网膜下腔出血诊断和治疗的临床价值[J].介入放射学杂志,2012,(09):711.
 LU Jing,LI Yong- dong,LI Ming- hua,et al. The clinical value of time- of-flight MRA in diagnosing and treating subarachnoid haemorrhage[J].journal interventional radiology,2012,(02):711.
[5]田红岸,赵 卫,易根发. 动脉灌注替罗非班在处理颅内动脉瘤栓塞术中急性血栓栓塞的研究[J].介入放射学杂志,2012,(09):718.
 TIAN Hong- an,ZHAO Wei,YI Geng-fa.. Application of intra- arterial infusion of tirofiban in dealing with acute thromboembolism occurred during embolization therapy for intracranial aneurysms: a preliminary study[J].journal interventional radiology,2012,(02):718.
[6]巩 亮,姜黔峰,商黔惠,等. 应用小腰大边室间隔缺损封堵器治疗主动脉窦瘤破裂的临床研究[J].介入放射学杂志,2012,(09):722.
 GONG Liang,JIANG Qian- feng,SHANG Qian- hui,et al. Treatment of ruptured sinus Valsalva aneurysm with domestic thin- waist- big- side ventricular septal defect occluder: a clinical study[J].journal interventional radiology,2012,(02):722.
[7]陈 状,李 林,王伟民,等. SolitaireAB支架结合弹簧圈治疗颅内宽颈动脉瘤的初步经验[J].介入放射学杂志,2013,(06):447.
 CHEN Zhuang,LI Lin,WANG Wei? min,et al. SolitaireAB stent- assisted coiling of intracranial wide- necked aneurysms: preliminary experience[J].journal interventional radiology,2013,(02):447.
[8]田红岸,赵 卫,易根发. 颅内动脉瘤内支架辅助治疗的并发症分析[J].介入放射学杂志,2012,(11):885.
 TIAN Hong- an,ZHAO Wei,YI Geng- fa.. Endovascular stent- assited management for the treatment of intracranial aneurysms: an analysis of complications[J].journal interventional radiology,2012,(02):885.
[9]温宏峰,赵春霞,李继来,等. 双微导管技术栓塞颅内宽颈不规则动脉瘤[J].介入放射学杂志,2012,(11):890.
 WEN Hong- feng,ZHAO Cun- xia,LI Ji- lai,et al. Double microcatheter technique for detachable coil treatment of wide?蛳 necked and irregular intracranial aneurysms[J].journal interventional radiology,2012,(02):890.
[10]崔艳峰,徐 浩,祖茂衡,等. Solitaire AB支架在辅助栓塞颅内宽颈动脉瘤中的临床应用[J].介入放射学杂志,2013,(08):617.
 CUl Yan? feng,XU Hao,ZU Mao? heng,et al. Clinical application of Solitaire AB stent in assisting coiling embolization for intracranial wide?蛳 necked aneurysms[J].journal interventional radiology,2013,(02):617.

备注/Memo

备注/Memo:
(收稿日期:2014-09-26)
(本文编辑:边 佶 )
更新日期/Last Update: 2015-02-15