Clinical Study Of Endovascular Interventional Treatment Of Anterior Communicating Aneurysm With Dysplasia Or Absence Of A1 Segment Of Anterior Cerebral Artery

Objective: To retrospectively collect and analyze the clinical data and follow-up results of endovascular interventional treatment of anterior communicating artery aneurysm(Acom A),and explore the safety and effectiveness of endovascular interventional treatment for Acom A with dysplasia or absence of A1 segment of anterior cerebral artery,analyze the influence of dysplasia or absence of A1 anterior cerebral artery on the treatment and prognosis of Acom A.Methods: Collected inpatient and outpatient follow-up data of patients with anterior communicating aneurysm undergoing endovascular interventional therapy in the Department of Neurosurgery of the Affiliated Hospital of Southwest Medical University from June 2015 to June 2019,including the general personal information,past medical history,and neurological function classification at admission,cerebral CT plain scan modified fisher classification,morphological characteristics of anterior communicating aneurysm,bilateral anterior cerebral artery diameter,surgery-related complications,immediate postoperative aneurysm imaging results,and post-discharge outpatient or telephone follow-up data,evaluated by Raymond scale for aneurysm embolism,follow-up results of clinical prognosis were evaluated by modified rankin scale(m RS)scoring system.Anterior communicating aneurysms with one anterior cerebral artery dysplasia or absence of A1 segment were classified as group A,and the remaining included in the treatment were classified as group B.In the Hunt-Hess grading,modified fisher scale,surgery-related complications,immediate postoperative aneurysm embolization degree,aneurysm recurrence,and follow-up results,m Rs scores were compared whether there was a statistically significant difference between the two groups.SPSS25.0 software was used to check The clinical data.The quantitative data used t test,and the qualitative data used chi-square test or Fisher’s exact test.When the P value was less than 0.05,the difference was statistically significant.Results: A total of 91 patients were included in this study,of which 40 were males(41/91)and 51 were females(51/91),and the male to female ratio was 1:1.28.The range of age was 35-77 years old,with an average of 54.8±9.6 years old.Among 91 patients,38 cases were ruptured aneurysms in group A,2 cases were unruptured aneurysms,47 cases were ruptured aneurysms in group B,and 4 cases were unruptured aneurysms.The patient was admitted to the hospital mainly for headache,dizziness,vomiting,epilepsy and other reasons.All 91 patients underwent endovascular intervention successfully.In group A,40 cases(44.0%)were combined with dysplasia or absence of A1 segment on one side,and 51 cases(56.0%)were in group B.23 cases were dysplasia of the A1 segment of the anterior cerebral artery during routine cerebrovascular angiography(25.3%),17 cases(18.7%)were absence of the A1 segment,and the contralateral carotid artery was compressed.it was confirmed that the A1 segment of one anterior cerebral artery was truly absent in 7 cases(7.7%)during cerebral angiography again,10 cases(11.0%)of severe dysplasia.There was no significant difference between group A and group B in general data,and there was no significant difference between group A and group B in data after admission,such as Hunt-Hess grade of neurological function,wide-necked aneurysm,modified Fisher scale of subarachnoid hemorrhage,operation time,hospitalization days,Raymond scale of communicating aneurysm embolism immediately before angiography,and there was no significant difference between group A and group B in intraoperative complications.The analysis showed that the incidence of dysplasia or absence of A1 segment was related to the left and right sides,and the dysplasia or absence of A1 segment on the right side(26/91)was more than that on the left side(14/91),with statistical significance(P = 0.010).Use of stents in group A and group B: 17 cases(17/40)in group A and 11 cases(11/51)in group B were treated with stent-assisted coil technology.compared with group B,group A had higher use rate of stents,and the difference was statistically significant.With regard to the recurrence in follow-up,there were 2 cases(2/40)of anterior communicating artery aneurysms in group A and 1 case(1/51)in group B.The recurrence rate in group B was lower than that in group A,but the difference was not statistically significant(P=0.580).The postoperative Raymond scale of 2 patients with recurrence in group A and 1 patient with recurrence in group B were all grade 3.Conclusion: 1.When dysplasia or absence of A1 segment of unilateral anterior cerebral artery occurred,endovascular interventional treatment of anterior communicating artery aneurysm was safe and effective.2.The incidence of dysplasia or absence of unilateral anterior cerebral artery A1 segment was higher in patients with anterior communicating aneurysm than in the general population;3.There was a difference in dysplasia or absence of the A1 segment of the left and right anterior cerebral artery,and the incidence of the A1 segment of the right anterior cerebral artery was higher;4.Intravascular interventional therapy combined with dysplasia or absent anterior communicating aneurysm of A1 segment of one anterior cerebral artery,the stent usage rate was higher.