Analysis Of Rupture Risk Factors In The Middle Cerebral Artery

Objective:The incidence of cerebral aneurysm is relatively high(3-5%).With the popularity of CTA and MRA,more and more unruptured aneurysms have been detected.The study on the risk factors of aneurysm rupture is very important for clinical treatment decisions.The proportion of cerebral aneurysm in cerebral aneurysm is about 18%to 40%,but there are few studies on the risk factors of cerebral aneurysm rupture.Therefore,we intend to explore the risk factors of aneurysm rupture at the bifurcation of the middle cerebral artery by analyzing the general clinical characteristics of aneurysm patients and the morphological parameters of aneurysm,so as to provide a basis for clinical treatment decisions.Methods:The clinical data and vascular imaging data of middle cerebral aneurysm patients admitted to the First Department of Neurosurgery of the First Affiliated Hospital of Kunming Medical University from 2013 to 2020 were collected.A total of 196 cases of aneurysms at the M1-M2 bifurcation of the middle cerebral artery were obtained,of which 119 cases had whole cerebral angiography images to obtain clinical features,morphology and morphological parameters.The remaining 77 cases were CTA or MRA images,and only general clinical data of the patients were collected.Use boxplot to find outliers in the data and review the outliers.All data,including clinical characteristics and aneurysm morphological parameters,were analyzed using SPSS23.0 software.For comparison between groups,independent sample t test was used for measurement data,and Pearson chi-square test was used for counting data.In order to exclude the influence of confounders,the variables of statistical significance in univariate analysis and some of the variables in extensive studies were analyzed by binary logistic regression to identify independent risk factors.And part of the measurement data to do ROC curve,by calculating the maximum approximate index,find out the best predicted value and calculate AUC area.Results:In our study,the results of the general clinical features(ruptured group vs unruptured group)showed that:Age(53.36±7.53vs55.11±9.82),sex(38.2%vs43.6%in male,61.8%vs56.4%in female),history of hypertension(37.3%vs41.5%,no 62.7%vs58.5%),systolic blood pressure(142.63±2.24vs129.55±19.51),diastolic blood pressure(86.56±13.96vs82.21±12.43),blood glucose at admission(6.94 ±1.84vs5.81±1.71),blood lipid indexes(HDL1.26±0.35vs1.1±0.32,LDL2.73 ±0.83vs2.58±1.00),Tc 4.30±0.98vs4.30±1,09,TG1.26±0.41 vs1.77±1.50),smoking history(15.7%vs23.4%,No smoking(84.3%vs76.6%),annual smoking amount(924.42±2352.84vs1431.11±3207.98),years of smoking(26.88±7.50vs25.91 ±7.81).The indicators with statistical significance in univariate analysis were:systolic blood pressure(P<0.01),diastolic blood pressure(P=0.02),blood glucose on admission(P<0.01),and HDL(P=0.02)(Table 4).The results of morphological parameter analysis(rupture group vs non-rupture group)were as follows:Length(5.50±3.43vs5.35±3.74),width(5.19±3.23vs5.41±3.24),aneurysm neck(4.19 ±2.52vs4.48±2.17),parent artery width(2.17±0.62vs2.13±0.65),aneurysm volume(171.5±381.7)1vs192.44±497.08),neck area(18.67 ±28.94vs19.43±19.93),V/S(10.42±24.69vs6.74±8.27),AR(1.38±0.74vs1.21±0.54),L/W(1.15±0.44vs1.04 ±0.44),SR(2.59±1.62vs2.91±2.78),ascus(78.4%vs21.6%,32.9%vs67.1%),morphology(48.25%vs84.15%regular,51.8%vs15.9%irregular),Among them,the indicators of statistical significance in univariate analysis were ascomas(P<0.01),regular and irregular in morphology(P<0.01)(Table 5).In the multivariate analysis,the results were statistically significant:systolic blood pressure at admission(P=0.02)and tumor neck area(P=0.038)(Table 6).Conclusion:Systolic blood pressure,diastolic blood pressure,blood glucose,HDL,ascomysms,irregular shape and aneurysm neck area are correlated with aneurysm rupture at middle cerebral artery biforking.Systolic blood pressure and tumor neck area were independent risk factors for tumor rupture at the bifurcation of the middle cerebral artery.