镜像动脉瘤发生、影像学及治疗

Genesis,ImagingandTreatmentofIntracranialMirrorAneurysms(MirANs)InstituteofDiagnosticandInterventionalRadiology,TheSixthAffiliatedPeople’sHospital,ShanghaiJiaoTongUniversityTANHUA-QIAOMD.Ph.D.DefinitionofMirANUncommon，specialsubgroupofmutipleintracranialaneurysms;occuringatroughlythesamelocationoneachsideinthesamepatientwithoutconsideringthesizeoftheaneurysms.↙↘→←HypothesisongenesisandgrowthofMirANsAdifferentetiologicprocessoccursinmirroraneurysmdisease.Acongenitalpredisposition,andtheearlyembryologicalderangementofvascularwallformationmightbeoneoftheirunderlyingcauses.EarlyruptureinpatientswithnoextrinsicriskfactorssupporttheroleofacongenitalpredispositionoverdegenerativecausesinthepatientswithMirAN.Hemodynamicforcesmightberesponsiblefortriggeringthedevelopmentofananeurysmintheprimarilyabnormalvesselwall.EpidemiologyofMirANsPrevalence:Constitutelessthan5%ofoverallaneurysmsAccountforapproximately20%–30%amongmultipleaneurysmsFamilialandtwinintracranialaneurysm:65～70%Non-familial,sporadicintracranialaneurysm:～21%Ourresultfrom190patientsharboringmutipleintracranialaneurysmsbetweenJune2007andJuly2011MANsaccountfor26.3%amongmultipleaneurysmsEpidemiologyofMirANLocationCommonlocation:MCAbifurcationandPCoAreportedbyliteratureUncommonsite:ACAA1,Pericallosal,VertebralArteryOurresultfrom50patientswithMirANbetweenJune2007andJuly2011MCAbifurcation(10%)PCoA/C7(24%)C6(24%)C5(20%)C4(20%)Otherlocation(2%)EpidemiologyofMirANsGenderdistributionMirANVSnMirANswithmutipleintracranialaneurysms-Female/maleratio:3.1:1VS2.1:1Female/maleratioofMirANsandnMirANsincreasedwiththeage40-yearsMirANsVSnMirANs:1.5:1VS1:160-yearsMirANsVSnMirANs:7:1VS9:1Ourresultfrom50patientswithMirANbetweenJune2007andJuly2011Female/maleratio:2.3:1EpidemiologyofMirANsAverageageatpresentation/ruptureforMirANsandnMirANspatientswasinthe5thdecadeWomenpresentedlaterthanmeninMirANsandnMirANsOurresultfrom50patientswithMirANsMeanageofMirANspresentation：62.4±12.5yearsWomenvsMenforMirANs：62.1±12.3vs63±13.4(P0.05)SAHoccurredin13of30intracranialMirAnpatients(43.3%).AverageageofpatientswithrupturedMirANs:62.7±9.9Casimiro,MV，etal.SurgNeurol,2004;61:541–5EpidemiologyofMirANsRiskfactorsCigaretteSmokingMeanageatpresentationforMirAnsvsnMirAns:53.3±9.1vs48.7±11.7PeakageofruptureforMirAnsvsnMirAns:thestartofthe5thdecadevsthestartofthe6thdecadeHypertensionMeanageatpresentationinMirAnsvsnMirAns:58.7±9.2vs56±10.4Hypertensionwasthemostprevalentriskfactorinpatientspresentedafter60-yearsold;62.5%inMirAns,and30%innMirAns(P0.05)NoknownextrinsicriskfactorsTheagepatternofpresentationandruptureweredifferentbetweenMirAnandnMirAnwithoutrecognizedriskfactors.NoknownextrinsicriskfactorswasthemaincharacteristicofthesubsetofMirAnpatients40years.Casimiro,MV，etal.SurgNeurol,2004;61:541–5AgepatternofdiseasepresentationforthegeneralMirANpopulationandfortheriskfactorsHBP=Highbloodpressure,S=Cigarettesmoking,andnRF=Noknownextrinsicriskfactors.Agepatternofdiseasepresentationforthegeneralno-MirANpopulationandfortheriskfactorsHBP=Highbloodpressure,S=Cigarettesmoking,andnRF=Noknownextrinsicriskfactors.RelativeprevalenceofeachriskfactorbyagegroupinMirAnHBP=Highbloodpressure,S=Cigarettesmoking,andnRF=Noknownextrinsicriskfactors.RelativeprevalenceofeachriskfactorbyagegroupinnMirAnHBP=Highbloodpressure,S=Cigarettesmoking,andnRF=Noknownextrinsicriskfactors.MirANsdiagnosisapproachesMRACTADSAMirANswereClassifiedas2type:Ⅰtype:completesymmetryⅡtype:incompletesymmetryMirANsdiagnosisandclassificationIdentificationofdutylesiononMirANsCT/MRIHematomasite/themostthicksiteofSAHCTA/MRA/DSAAneurysmsizeAneurysmmorphologyParentarteryand/oradjacentarteryspasmⅠtypeMirANs↓↓←←ⅡtypeMirANs↘↘←←Therapeuticdecision-makingonMirANsWhetherintracranialunrupturedMirANsshouldbetreated?Dependonthewellknownfactorssuchasageofthepatient,localizationandsizeoftheaneurysm.shouldbediscussedwiththeaffectedpatientonanindividualbasis.Iftreatmentisconsidered,whichchoiceoftreatmentshouldbeemployed,surgicalclippingorendovascualrtreatment?DependonthelocationandaneurysmfeaturesIftreatmentisperformed,theonestageoperationortwostageoperationwaschoose.Thefirstchoiceisonestageoperation,butifthepatientisnotsuitforonestageoperation,thedutyaneurysmshouldbetreatedfirstCase1M,64Y,progressiveenlargementofincidentlyfoundaneurysmPre-embolizationPost-embolizationPre-embolizationPost-embolizationCase2F,57Y,SAHLRLRRLPre-embolizationPost-embolizationLLPre-embolizationPost-embolization