血管內治療前交通破裂動脈瘤患者手術相關并發癥影響因素的研究進展

【摘要】 交通動脈是溝通兩側前循環的重要中間血管，前交通動脈瘤（ACoAAs）是最常見的顱內動脈瘤發生部位和蛛網膜下腔出血來源。血管內治療破裂ACoAAs往往伴隨著嚴重的并發癥風險，從而影響患者預后。因此，早期發現可能導致介入治療破裂ACoAAs患者發生手術相關并發癥，提前制定決策，進行個體化干預和治療，對改善患者預后，降低病死率、致殘率具有重要意義。本文結合目前國內外研究進展，對血管內治療破裂ACoAAs患者手術相關并發癥影響因素進行綜述，從而為臨床醫生的早期干預時機和治療決策提供參考。

【關鍵詞】 前交通動脈瘤；蛛網膜下腔出血；手術相關并發癥；血流動力學；形態學

【中圖分類號】 R743" 【文獻標志碼】 A" 【文章編號】 1672-7770（2025）01-0109-05

Advances in endovascular treatment of procedure-related complications in patients with ruptured anterior communicating artery aneurysms

Abstract： The anterior communicating artery is an important intermediate vessel that communicates between the two sides of the anterior circulation， and anterior communicating artery aneurysms（ACoAAs） are the most common site of intracranial aneurysms and presenting with subarachnoid haemorrhage. Endovascular treatment of ruptured ACoAAs is often accompanied by the risk of serious complications， thus worsen patient prognosis. Therefore， early identification of risk factors that may lead to procedure-related complications in patients with interventional treatment of ruptured ACoAAs， and advance decision-making for individualised intervention and treatment are of great significance in improving patient prognosis and reducing the rate of death and disability. This article reviews the factors affecting surgery-related complications in patients with ruptured ACoAAs treated with endovascular therapy in the light of current research progress at home and abroad， so as to provide reference for clinicians’ early intervention timing and treatment decisions.

Key words： anterior communicating artery aneurysm; subarachnoid hemorrhage; procedure-related complication;" hemodynamic;" morphology

顱內動脈瘤（intracranial aneurysms，IAs）是一種臨床上較為常見的對人類健康構成重大威脅的腦血管疾病。由多種原因導致的動脈瘤破裂，血液流入腦脊液中，形成蛛網膜下腔出血（subarachnoid haemorrhage，SAH），動脈瘤破裂所致的SAH約占自發性SAH的85%。近年來，動脈瘤破裂的發生率正逐年上升，目前僅次于腦出血和腦血管栓塞，在所有腦血管意外中位居第三位。據報道，IAs破裂患者30 d內病死率超過40%，且具有較高的致殘率［1］。

前交通動脈復合體包括前交通動脈和與之相連的兩側大腦前動脈A1段及其各穿支血管，它位于視交叉上方，毗鄰下丘腦等重要部位，此處血管存在諸多轉折和分叉，解剖結構復雜，且該區域血管變異較多，據統計，前交通動脈瘤（anterior communicating artery aneurysms，ACoAAs）發生率在所有類型腦動脈瘤所占比例約為1/3［2］，是最常見的顱內動脈瘤發生部位和SAH來源，并且在年輕人群中，ACoAAs破裂更為常見［3］。……