前循环动脉瘤破裂与未破裂时颈内动脉迂曲度的差异。匹配病例对照研究。

IF 1.5 4区医学 Q4 CLINICAL NEUROLOGY

Neurochirurgie Pub Date : 2024-11-07 DOI:10.1016/j.neuchi.2024.101613

Noemi Cinti , Paul J. McKeegan , Peter J. Bazira , Aubrey Smith , Paul Maliakal , Mihai Danciut , Hamed Nejadhamzeeigilani

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引用次数: 0

摘要

目的：颈内动脉迂曲被认为是颅内动脉瘤形成的原因之一，但有关其作为动脉瘤破裂风险因素的文献却很少。因此，本研究调查了颈内动脉（cICA）迂曲对大脑前循环动脉瘤破裂的影响：方法：对在一家三级中心接受血管内栓塞术治疗前循环动脉瘤的患者进行血管造影检查。83名有动脉瘤破裂和蛛网膜下腔出血病史的患者（SAH组）与83名未破裂动脉瘤的患者（对照组）在年龄、动脉瘤位置和大小、蛛网膜下腔出血病史和高血压方面进行了配对：在 SAH 组和对照组中，分别有 33.7% 和 56.6% 的患者发现了主观 cICA 扭转（OR 0.39 [95% CI 0.21-0.75]）。SAH组和对照组分别有35.7%和46.8%的患者存在客观cICA迂曲（OR 0.63 [95% CI 0.32-1.27]）。尽管客观结果的统计学意义有限，但OR值提示cICA迂曲是动脉瘤破裂的阴性预测因子，主观评估的预测能力更强：这项研究表明，与破裂的动脉瘤相比，未破裂的动脉瘤中 cICA 扭转的存在率更高，这表明 cICA 扭转不太可能成为动脉瘤破裂的风险因素。对未经治疗的动脉瘤进行纵向观察研究，将有助于将 cICA 扭转作为一种保护因素进行研究。

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Differences in internal carotid artery tortuosity in ruptured and unruptured anterior circulation aneurysms. A matched case-control study

Objective

Tortuosity of the internal carotid artery is believed to contribute to the formation of intracranial aneurysms, although there is scant literature on its role as a risk factor for rupture specifically. Therefore, this study investigated the influence of cervical internal carotid artery (cICA) tortuosity on rupture of aneurysms of the anterior cerebral circulation.

Methods

Angiographic imaging studies from patients who underwent endovascular embolisation for anterior circulation aneurysms at a tertiary centre were identified. 83 patients with a history of aneurysmal rupture and subarachnoid haemorrhage (SAH group) were matched for age, aneurysm location and size, history of subarachnoid haemorrhage and hypertension to 83 subjects with unruptured aneurysms (control group). cICA tortuosity was assessed utilising subjective (kinks, loops or coils) and objective (tortuosity index) parameters.

Results

Subjective cICA tortuosity was identified in 33.7% and 56.6% of patients in the SAH and control groups respectively (OR 0.39 [95% CI 0.21–0.75]). Objective cICA tortuosity was present in 35.7% and 46.8% of SAH and control patients (OR 0.63 [95% CI 0.32–1.27]). OR values are suggestive of cICA tortuosity as a negative predictor of aneurysmal rupture, with more predictive power attributed to the subjective assessment, despite the limited statistical significance of the objective results.

Conclusions

This study demonstrated an increased presence of cICA tortuosity in unruptured aneurysms compared to ruptured aneurysms, suggesting it is unlikely to represent a risk factor for rupture. Further research in the form of longitudinal observational studies of untreated aneurysms would aid in investigating cICA tortuosity as a protective factor.

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来源期刊

Neurochirurgie 医学-临床神经学

CiteScore

2.70

自引率

6.20%

发文量

100

审稿时长

29 days

期刊介绍： Neurochirurgie publishes articles on treatment, teaching and research, neurosurgery training and the professional aspects of our discipline, and also the history and progress of neurosurgery. It focuses on pathologies of the head, spine and central and peripheral nervous systems and their vascularization. All aspects of the specialty are dealt with: trauma, tumor, degenerative disease, infection, vascular pathology, and radiosurgery, and pediatrics. Transversal studies are also welcome: neuroanatomy, neurophysiology, neurology, neuropediatrics, psychiatry, neuropsychology, physical medicine and neurologic rehabilitation, neuro-anesthesia, neurologic intensive care, neuroradiology, functional exploration, neuropathology, neuro-ophthalmology, otoneurology, maxillofacial surgery, neuro-endocrinology and spine surgery. Technical and methodological aspects are also taken onboard: diagnostic and therapeutic techniques, methods for assessing results, epidemiology, surgical, interventional and radiological techniques, simulations and pathophysiological hypotheses, and educational tools. The editorial board may refuse submissions that fail to meet the journal''s aims and scope; such studies will not be peer-reviewed, and the editor in chief will promptly inform the corresponding author, so as not to delay submission to a more suitable journal. With a view to attracting an international audience of both readers and writers, Neurochirurgie especially welcomes articles in English, and gives priority to original studies. Other kinds of article - reviews, case reports, technical notes and meta-analyses - are equally published. Every year, a special edition is dedicated to the topic selected by the French Society of Neurosurgery for its annual report.