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目的探讨大脑前动脉A1段缺如及重度发育不良对前交通动脉瘤介入治疗的影响。方法回顾性分析接受全脑DSA检查的905例患者临床资料,对CTA、常规DSA疑有单侧A1段缺如患者作压迫对侧颈动脉(压颈)造影,判断A1段是否真正缺如,同时分析其中68例前交通动脉瘤患者临床资料、血管内栓塞治疗过程及随访结果。结果 905例患者经CTA或常规DSA检查有40例表现为大脑前动脉A1段缺如,压颈造影后真正缺如30例,10例为重度发育不良。68例前交通动脉瘤患者中单侧A1缺如16例,重度发育不良4例,轻中度发育不良7例。所有前交通动脉瘤患者均成功接受介入栓塞治疗,其中可解脱式弹簧圈单纯栓塞39例,支架辅助栓塞29例;16例A1段缺如和4例重度发育不良患者中有13例接受支架辅助栓塞。术后即刻动脉瘤完全闭塞56例(82.3%),瘤颈残留10例(14.7%),瘤腔残留2例(3%)。术后48例获临床和影像学随访,3例(6.3%)明显复发,其中2例成功接受再次栓塞治疗。结论对CTA和常规DSA造影疑有单侧大脑前动脉A1段缺如的前交通动脉瘤患者,压颈造影能够鉴别A1段是否真正缺如。单侧A1段缺如及重度发育不良的前交通动脉瘤介入治疗时,应确保前交通动脉及双侧A2段通畅,使用支架辅助栓塞有一定帮助。
Objective To investigate the effect of the absence of A1 segment of anterior cerebral artery and severe dysplasia on the interventional treatment of anterior communicating artery aneurysm. Methods The clinical data of 905 patients who underwent whole brain DSA were retrospectively analyzed. The contralateral carotid artery (compression neck) was diagnosed in patients with CTA and conventional DSA who lacked the unilateral A1 segment, At the same time, 68 cases of anterior communicating artery aneurysm were analyzed, including the clinical data, the course of endovascular embolization and the follow-up results. Results 905 cases of CTA or conventional DSA examination showed 40 cases of absence of anterior segment of the anterior segment of the brain, lack of neck true absence of 30 cases, 10 cases of severe dysplasia. 68 cases of anterior communicating aneurysms in patients with unilateral absence of A1 in 16 cases, severe dysplasia in 4 cases, mild to moderate dysplasia in 7 cases. All anterior communicating aneurysms were successfully treated with interventional embolization, including 39 cases of simple embolization of coil spring and 29 cases of stent-assisted embolization. Thirteen of 16 patients with A1 deficiency and 4 cases of severe dysplasia received stent-assisted embolism. Fifty-two patients (82.3%) had aneurysm occlusion immediately after operation, 10 (14.7%) residual neoplasms and 2 (3%) residual aneurysms. Forty-eight patients were followed up clinically and radiologically. Three patients (6.3%) were significantly recurred. Two of them were successfully embolized. Conclusions For patients with anterior communicating aneurysms suspected of having an unilateral segmental anterior segment of the anterior cerebral artery in CTA and conventional DSA angiography, neck compression can identify whether the segment A1 is truly absent. Unilateral A1 segment absent and severe dysplasia of the anterior communicating artery aneurysm interventional treatment, should ensure that the anterior communicating artery and bilateral A2 segment unobstructed, the use of stent-assisted embolization has some help.