大脑前动脉A1段的显微解剖与数字减影血管造影对照观测及临床意义

目的 为临床选择颅内血管支架的类型和放置部位提供解剖学基础。方法 选取尸头标本20具,经双侧翼点入路显微解剖观测大脑前动脉A1段及其穿支血管。选取无病变的全脑DSA 100例,观测大脑前动脉A1段的走行及其穿支的开口部位。结果 显微解剖大脑前动脉A1段的长度和直径分别为（13.55±1.43） mm、（2.43±0.37） mm,DSA血管造影的长度和直径分别为（13.42±1.57） mm、（2.28±0.40） mm,显微解剖与DSA血管造影直径的差异有统计学意义（P〈0.05）。大脑前动脉A1段的穿支发自其后上壁,近侧段穿支数目（2.55±0.39）支,中间段（0.52±0.46）支,远侧段（1.12±0.11）支,近侧、中间、远侧段的穿支数目的差异均有统计学意义（P值均〈0.05）。男性较女性的大脑前动脉A1段长、直径粗,两者差异均有统计学意义（P值均〈0.05）。结论 大脑前动脉A1段的显微解剖与数字减影血管造影对照观测对临床选择颅内血管支架的类型和放置部位,避免血管支架阻塞穿支开口处,防止术后穿支供应区域缺血等具有重要的临床意义。

Microanatomy and digital subtraction angiography comparative observation of the A1 segment of anterior cerebral artery and its clinical significance

Objective To provide anatomical basis for selecting the types and placing parts of vascular stent. Methods Twenty head specimens were selected and the A1 segment of anterior cerebral artery and its perforators were measured by the pterion approach. One hundred digital subtraction angiography（DSA） images with no diseases of whole brain were selected, the course of the A1 segment of anterior cerebral artery and the opening parts of its perforators were observed. Results The length and external diameter of the microanatomy were （13.55±1.43）mm and （2.43±0.37）mm, respectively. The length and diameter of the DSA angiography of the A1 segment of anterior cerebral artery were （13.42±1.57）mm and （2.28±0.40）mm respectively. There were significant differences in the diameter between the microanatomy and DSA angiography （P〈0.05）. The perforators of the A1 segment of anterior cerebral artery originated from its posterior and superior wall, the branches of the proximal, middle and distal segment were 2.55±0.39, 0.52±0.46, and 1.12±0.10, respectively. There were significant differences in the perforators among the proximal, middle and distal segment （all P values〈0.05）. The male A1 segment of anterior cerebral artery was longer than that of the female, there were significant differences in length and diameter respectively （all P values〈0.05）. Conclusions Microanatomy and digital subtraction angiography comparative observation of the A1 segment of anterior cerebral artery has an important clinical significance for selecting the types and placing parts of vascular stent, avoiding obstruction the opening parts of perforators, preventing postoperative ischemia of the supply area of perforators.