Bifurcation geometry and the presence of cerebral artery aneurysms

Ingebrigtsen, Tor; Morgan, Michael K.; Faulder, Ken; Ingebrigtsen, Linda; Sparr, Trygve; Schirmer, Henrik

doi:10.3171/jns.2004.101.1.0108

Cited by 151 publications

(134 citation statements)

References 16 publications

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“…Hemodynamic stress at arterial bifurcations are believed to contribute to aneurysm development (Ingebrigtsen et al 2004). However, it is largely unknown why only some adults develop aneurysms at bifurcations and most do not.…”

Section: Pathology Epidemiology and Etiologymentioning

confidence: 99%

The genetics of intracranial aneurysms

Krischek

Inoue

2006

J Hum Genet

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The rupture of an intracranial aneurysm (IA) leads to a subarachnoid hemorrhage, a sudden onset disease that can lead to severe disability and death. Several risk factors such as smoking, hypertension and excessive alcohol intake are associated with subarachnoid hemorrhage. IAs, ruptured or unruptured, can be treated either surgically via a craniotomy (through an opening in the skull) or endovascularly by placing coils through a catheter in the femoral artery. Even though the etiology of IA formation is mostly unknown, several studies support a certain role of genetic factors. In reports so far, genome-wide linkage studies suggest several susceptibility loci that may contain one or more predisposing genes. Studies of several candidate genes report association with IAs. To date, no single gene has been identified as responsible for IA formation or rupture. The identification of susceptible genes may lead to the understanding of the mechanism of formation and rupture and possibly lead to the development of a pharmacological therapy.

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Section: Pathology Epidemiology and Etiologymentioning

confidence: 99%

The genetics of intracranial aneurysms

Krischek

Inoue

2006

J Hum Genet

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“…The present study highlights the five different branching patterns of the basilar artery studied in 170 human cadaveric brains. Various branching patterns in the termination of the artery subjects it to abnormal flow and leads to atherosclerotic changes and aneurysms (6,9). These variations may complicate surgery at the basilar tip at the clivus (4).…”

Section: Pentafurcation Of Basilar Arterymentioning

confidence: 99%

Anatomical variability in termination of basilar artery in human cadaveric brain

Gunnal

Farooqui²,

Wabale³

2015

Turkish Neurosurgery

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AIm:The basilar artery (BA) is the prominent median vessel of the vertebrobasilar circulation and usually terminates into two posterior cerebral arteries forming the posterior angle of the Circle of Willis (CW). To tackle different variations of CW, basilar artery acts as a guideline for neuroradiologists and neurosurgeons. Basilar termination is the most frequent site of aneurysm. Abnormalities at the site of termination may compress the oculomotor nerve. Variations at the termination may complicate surgeries at the base of brain. The present study aims to add to the knowledge regarding the termination pattern of the BA. mATeRIAL and meTHods: 170 BA terminations were studied. Morphological variations in the termination pattern were noted. Frequency of variations in termination patterns was recorded. Dimensions of BA were measured. Data were analyzed.ResuLTs: Morphological variations in termination were seen in 17.64%. Bifurcation, Trifurcation, Quadrifurcation, Pentafurcation and Nonfurcation of BA was seen in 82.35%, 5.29%, 5.88%, 3.52% and 2.94% respectively. BA associated with aneurysm and Fenestration was seen in 3.52% and 1.17% respectively. Mean length and diameter of BA was 30.27 mm and 4.8 mm respectively.

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“…1,4,17 Indeed, it has been suggested that a particular bifurcation phenotype may be directly linked to intracranial aneurysms (IAs). 11 An optimal arrangement of branching and bifurcation sites in the cerebral vasculature is essential to preserve minimum energy expenditure along the network by maintaining constant wall shear stress (WSS) across daughter and parent vessels. 11,25 This vascular optimality principle has been shown to generally apply to the cerebral circulation 11,19,20 and implies a relative optimal bifurcation angle depending on the relative sizes of the daughter branches.…”

confidence: 99%

Widening of the basilar bifurcation angle: association with presence of intracranial aneurysm, age, and female sex

Tütüncü¹,

Schimansky²,

Baharoglu³

et al. 2014

JNS

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Object. Arterial bifurcations represent preferred locations for aneurysm formation, especially when they are associated with variations in divider geometry. The authors hypothesized a link between basilar apex aneurysms and basilar bifurcation (a) and vertebrobasilar junction (VBJ) angles.Methods. The a and VBJ angles were measured in 3D MR and rotational angiographic volumes using a coplanar 3-point technique. Angle a was compared between age-matched cohorts in 45 patients with basilar artery (BA) aneurysms, 65 patients with aneurysms in other locations (non-BA), and 103 nonaneurysmal controls. Additional analysis was performed in 273 nonaneurysmal controls. Computational fluid dynamics (CFD) simulations were performed on parametric BA models with increasing angles.Results. Angle a was significantly wider in patients with BA aneurysms (146.7° ± 20.5°) than in those with non-BA aneurysms (111.7° ± 18°) and in controls (103° ± 20.6°) (p < 0.0001), whereas no difference was observed for the VBJ angle. A wider angle a correlated with BA aneurysm neck width but not dome size, which is consistent with CFD results showing a widening of the impingement zone at the bifurcation apex. BA bifurcations hosting even small aneurysms (< 5 mm) had a significantly larger a angle compared with matched controls (p < 0.0001). In nonaneurysmal controls, a increased with age (p < 0.0001), with a threshold effect above 35 years of age and a steeper dependence in females (p = 0.002) than males (p = 0.04).Conclusions. The a angle widens with age during adulthood, especially in females. This angular widening is associated with basilar bifurcation aneurysms and may predispose individuals to aneurysm initiation by diffusing the flow impingement zone away from the protective medial band region of the flow divider. (http://thejns.org/doi/abs/10.3171/2014 key WorDS • vessel morphology • basilar bifurcation • vascular disorders • bifurcation aneurysms • vascular age dependencyAbbreviations used in this paper: AUC = area under the curve; BA = basilar artery; CFD = computational fluid dynamics; IA = intracranial aneurysm; MPR = multiplanar reconstruction; MRA = MR angiography; PCA = posterior cerebral artery; ROC = receiver operating characteristic; VBJ = vertebrobasilar junction; WSS = wall shear stress.

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Bifurcation geometry and the presence of cerebral artery aneurysms

Cited by 151 publications

References 16 publications

The genetics of intracranial aneurysms

The genetics of intracranial aneurysms

Anatomical variability in termination of basilar artery in human cadaveric brain

Widening of the basilar bifurcation angle: association with presence of intracranial aneurysm, age, and female sex

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