The Correlation Between The Variation Of The A1 Segment Of Anterior Cerebral Artery And The Endovascular Treatment Of Anterior Communicating Artery Aneurysms

Part One The correlation between the variation of the A1 segment of anterior cerebral artery and the formation of anterior communicating artery aneurysmObjective: This study was designed to evaluate the incidence of A1 segment of anterior cerebral artery hypoplasia and aplasia and prevalence of anterior communicating artery aneurysms, and to explore the correlation between the A1 segment variation and the formation of anterior communicating artery aneurysm based on cerebral digital subtraction angiography.Methods: We retrospectively analyzed the records of patients who underwent cerebral digital subtraction angiography examination in the department of neurointervention of The First Affiliated Hospital of Zheng Zhou University between September 2014 and Jun 2015. Evaluate the incidence of hypoplasia and aplasia of A1 segment, anterior communicating artery aneurysm, other location aneurysm and non- aneurysm, respectively. Then we grouped according to A1 segment development status, gender, the side of variation and the location of aneurysm, respectively. The differences in the incidence of A1 segment hypoplasia and aplasia were compared between these groups.Results: A total of 905 cases of patients conform to the inclusion criteria. Of them,434(47.9%)were men and 471(52.1%)were women. The mean age of the patients was 49.4 years and age range from 8 to 89 years. A total of 101 cases the A1 segment was hypoplasia and 30 cases the A1 segment was aplasia, the incidence of variation were 11.2% and 3.3%,respectively. Among whom 83(9.1%) cases right side A1 variation and 48(5.3%) cases left side variation. The incidence of right variation was higher than the left side,and the difference was statistically significant(?2=10.08,p<0.05). The incidence of A1 variation was 16.1%(71/434) in the males, which was higher than 12.7%(60/471) in the females, without statistically significant difference(P>0.05).Among the 905 patients who underwent cerebral digital subtraction angiography examination, 68 patients were identified with Acom A aneurysms, other location aneurysms 337 cases, and without aneurysms 500 cases. Among them, the incidence of A1 variation was 39.7%(27/68),13.7%(46/337),8.6%(58/500), respectively. The difference was statistically significant between Acom A aneurysms group and other location aneurysms group. The difference was statistically significant between Acom A aneurysms group and without aneurysms group, too. But the difference was not statistically significant between other location aneurysms group and without aneurysms group.Conclusion: Acom A aneurysm development appeared to be associated with A1 segment hypoplasia and aplasia. The A1 segment variation was more frequently observed in the right side and there was no difference between male and female.Part Two Correlation of development of A1 segment of anterior cerebral artery and the endovascular treatment of anterior communicating artery aneurysmsObjective: This study was designed to evaluate the development of A1 segment of anterior cerebral artery by cerebral digital subtraction angiography examination. Assess the effect of A1 development on endovascular treatment strategies of anterior communicating artery aneurysms.Methods: We retrospectively analyzed the records of patients who underwent cerebral digital subtraction angiography examination and endovascular treatment strategies of anterior communicating artery aneurysms in the department of neurointervention of The First Affiliated Hospital of Zheng Zhou University between September 2014 and Jun 2015.For the patients were suspected of A1 segment aplasia on computed tomographic angiography(CTA) ? magnetic resonance angiography(MRA) or conventional DSA angiography examination, in order to confirm whether A1 segment was really aplasia, the surgeon would compress the contralateral carotid artery and undergo the DSA angiography again. The clinical data of 68 patients with anterior communicating artery aneurysm, endovascular treatment strategy and follow-up results were analyzed retrospectively.Results: A total of 905 cases of patients underwent DSA angiography examination, among them, 40 cases were diagnosed A1 “aplasia” on CTA ?MRA and conventional DSA angiography examination, but when compress the contralateral carotid artery and undergo the DSA angiography again, there were 30 cases really aplasia, the other cases were diagnosed hypoplasia at last. A total of 68 cases of anterior communicating artery aneurysm patients underwent endovascular treatment. Among them, there were 16 cases A1 segment aplasia, 11 cases A1 segment hypoplasia. And 39 cases used GDC coils only, 29 cases used stent assisted technique. Of the 68 cases, total occlusion was achieved in 56(82.3%), residual neck in 10 patients(14.7%) and partial occlusion in 2 patients(3%).48 cases underwent DSA angiography during follow-up period, only 3 cases recanalization(6.3%).Conclusion: The development condition of A1 segment is important in endovascular treatment of the anterior communicating artery aneurysms. For the patients were suspected of A1 segment aplasia on computed CTA?MRA or conventional DSA angiography examination, It's highly necessary to identify A1 segment aplasia whether or not, it's helpful to compress the contralateral carotid artery and undergo the DSA angiography again. The anterior communicating artery and bilateral A2 segment should be kept patent in endovascular treatment of the anterior communicating artery aneurysms with A1 hypoplasia or aplasia, and it's helpful to use stent assisted technique.