태아형후대뇌동맥: 후교통동맥 동맥류 파열의 중요한 위험인자
Fetal-type Posterior Cerebral Artery: Significant Risk Factor for Posterior Communicating Artery Aneurysm Rupture
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초록
The fetal-type posterior cerebral artery(fPCA) is one of the anatomical variation of the circle of Willis. Unlike the typical posterior cerebral artery(PCA), the blood flow in the fPCA proceeds in the anterior circulation, not the posterior circulation. This causes blood flow primarily to the internal carotid artery(ICA)-posterior communicating artery(PComA)-posterior cerebral artery(PCA), which may continuously affect the vessel wall at the ICA-PComA bifurcation, causing a posterior commu- nicating artery aneurysm(PComAA) to develop and rupture. In this study, we considered fPCA as a significant risk factor for PComAA rupture and investigated association of fPCA and rupture of PComAA. A total of 543 aneurysms in 488 patients were investigated. The incidence of aneurysms was 141(25.9 %) in men and 402(74.1 %) in women. Among 490 aneurysms in the anterior circulation, the incidence of aneurysms was high in the order of Paraclinoid 147(30 %), AComA 142(28.9 %), PComA 98(20 %), and the rupture rate was in the order of AComAA(70.4 %) and PComAA(60.2 %). Of the 98 PComAA, 56 were fPCA and 42 were not, and the correlation between PComAA rupture and fPCA was significant(p<0.05). Therefore, fPCA should be recognized as an important risk factor for PComAA rupture, and individual and specific clinical management, such as shortening the follow-up examination period, is needed for patients with PComAA accompanied by fPCA to prevent aneurysm rupture.
Abstract
The fetal-type posterior cerebral artery(fPCA) is one of the anatomical variation of the circle of Willis. Unlike the typical posterior cerebral artery(PCA), the blood flow in the fPCA proceeds in the anterior circulation, not the posterior circulation. This causes blood flow primarily to the internal carotid artery(ICA)-posterior communicating artery(PComA)-posterior cerebral artery(PCA), which may continuously affect the vessel wall at the ICA-PComA bifurcation, causing a posterior commu- nicating artery aneurysm(PComAA) to develop and rupture. In this study, we considered fPCA as a significant risk factor for PComAA rupture and investigated association of fPCA and rupture of PComAA. A total of 543 aneurysms in 488 patients were investigated. The incidence of aneurysms was 141(25.9 %) in men and 402(74.1 %) in women. Among 490 aneurysms in the anterior circulation, the incidence of aneurysms was high in the order of Paraclinoid 147(30 %), AComA 142(28.9 %), PComA 98(20 %), and the rupture rate was in the order of AComAA(70.4 %) and PComAA(60.2 %). Of the 98 PComAA, 56 were fPCA and 42 were not, and the correlation between PComAA rupture and fPCA was significant(p<0.05). Therefore, fPCA should be recognized as an important risk factor for PComAA rupture, and individual and specific clinical management, such as shortening the follow-up examination period, is needed for patients with PComAA accompanied by fPCA to prevent aneurysm rupture.
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