Morphological and Hemodynamic Risk Factors for Middle Cerebral Artery Aneurysm: a Case-Control Study of 190 Patients

Kaspera, Wojciech; Ćmiel-Smorzyk, K.; Wolański, W.; Kawlewska, E.; Hebda, Anna; Gzik, M.; Ładziński, Piotr

doi:10.1038/s41598-019-56061-2

Cited by 22 publications

(25 citation statements)

References 38 publications

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“…Moreover, the parent vessel diameter was also one of the independent factors associated with the occurrence of IAs. These results are consistent with our previous report in which we showed that a larger radius of the parent MCA vessel was associated with a signi cant increase in the volume ow rate (VFR) (31). We also showed that VFR was a factor independently associated with the formation of MCA aneurysms.…”

Section: Discussionsupporting

confidence: 93%

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Morphometry of Cerebral Arterial Bifurcations Harbouring Aneurysms: A Case-Control Study On 253 Patients

Ćmiel-Smorzyk

Kawlewska

Wolański

et al. 2021

Preprint

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Background Conclusions from studies evaluating vessel dimensions and their deviations from the values resulting from the principle of minimum work (PMW) on the formation of intracranial aneurysms (IAs) are still inconclusive. The aim of our study was the morphometric analysis of cerebral arterial bifurcations harbouring aneurysms. Methods The study comprised 147 patients with basilar artery (BA) and middle cerebral artery (MCA) aneurysms, and 106 patients constituting the control group. The following morphometric parameters were evaluated: the radii of vessels forming the bifurcation, the junction exponent, the values of the bifurcation angles (Φ1 and Φ2 angles between the parent vessel trunk axis and the larger or smaller branches, respectively; α angle, total bifurcation angle) and the difference between the predicted optimal and observed branch angles. Results The analysed parameters for internal carotid artery (ICA) bifurcations were not significantly different among the groups. MCA and BA bifurcation angles and the radii of the parent MCA and BA vessels with aneurysms were significantly higher compared to the control group. The differences between the predicted optimal and observed branch angles were significantly higher for BA and MCA bifurcations with aneurysms compared to the control group. The mean junction exponent for bifurcations in the circle of Willis (i.e., ICA and BA bifurcations, respectively) and MCA bifurcations with aneurysms was significantly lower than the theoretical optimum and not significantly different among the groups. In a multilevel multivariate logistic regression analysis, the branch angles and the radius from the parent vessel were significant independent predictors of the presence of IAs. The ROC analysis indicated that the α angle was the best performer in discriminating between aneurysmal and non-aneurysmal bifurcations. Conclusions The dimensions of the arteries forming the circle of Willis do not follow the PMW. The deviation from optimum bifurcation geometry for bifurcations beyond the circle of Willis (particularly a wider radius of the parent artery and a wider total bifurcation angle) may lead to the formation of IAs. Further studies are warranted to investigate the significance of vessel dimensions and the bifurcation angle on the magnitude of the shear stress in the walls of arterial bifurcations.

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Section: Discussionsupporting

confidence: 93%

“…We also showed that VFR was a factor independently associated with the formation of MCA aneurysms. Of note, the comparison of blood velocity values for the parent MCA vessel performed in this study did not show differences between those patients with MCA aneurysms and the controls (31).…”

Section: Discussionmentioning

confidence: 46%

Morphometry of Cerebral Arterial Bifurcations Harbouring Aneurysms: A Case-Control Study On 253 Patients

Ćmiel-Smorzyk

Kawlewska

Wolański

et al. 2021

Preprint

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“…The WSS experienced at a bifurcation is dependent on its geometry, including the radii of all the vessels involved and the bifurcation angle of the arterial tree [45,46]. The increase in the asymmetry of the vascular diameters of bifurcations and the values of the bifurcation angles, and the decrease in the bilateral angles formed between the daughter and parent vessels and the inclination angle (formed between the parent vessel axis and the plane containing the axes of the two daughter vessels) likely contribute to abnormally enhanced haemodynamic stresses at the arterial bifurcations [26,[47][48][49][50][51][52][53]. Thus, arterial morphology and local haemodynamics are interrelated: the geometry directly determines the bloodflow parameters, while the flow drives arterial wall remodelling which determines the future geometry, promoting aneurysm formation.…”

Section: Discussionmentioning

confidence: 99%

“…All CT studies were performed using a 64-row 128-slice CT system (GE Optima CT 660, GE Healthcare, USA) using the parameters previously described [ 26 ]. On average, 50 ml of ionic contrast material (Iomeron 350, Bracco Imaging Deutschland GmbH, Konstanz, Germany) was injected into the basilic vein at 4–4.5 ml/sec via a selectively positioned catheter with the aid of an automatic syringe (OptiVantage DH, Mallincrodt, St Louis, MO, USA).…”

Section: Methodsmentioning

confidence: 99%

Wall shear stress gradient is independently associated with middle cerebral artery aneurysm development: a case-control CFD patient-specific study based on 77 patients

et al. 2021

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Background Previously published computational fluid dynamics (CFD) studies regarding intracranial aneurysm (IA) formation present conflicting results. Our study analysed the involvement of the combination of high wall shear stress (WSS) and a positive WSS gradient (WSSG) in IA formation. Methods We designed a case-control study with a selection of 38 patients with an unruptured middle cerebral artery (MCA) aneurysm and 39 non-aneurysmal controls to determine the involvement of WSS, oscillatory shear index (OSI), the WSSG and its absolute value (absWSSG) in aneurysm formation based on patient-specific CFD simulations using velocity profiles obtained from transcranial colour-coded sonography. Results Among the analysed parameters, only the WSSG had significantly higher values compared to the controls (11.05 vs − 14.76 [Pa/mm], P = 0.020). The WSS, absWSSG and OSI values were not significantly different between the analysed groups. Logistic regression analysis identified WSS and WSSG as significant co-predictors for MCA aneurysm formation, but only the WSSG turned out to be a significant independent prognosticator (OR: 1.009; 95% CI: 1.001–1.017; P = 0.025). Significantly more patients (23/38) in the case group had haemodynamic regions of high WSS combined with a positive WSSG near the bifurcation apex, while in the control group, high WSS was usually accompanied by a negative WSSG (14/39). From the analysis of the ROC curve for WSSG, the area under the curve (AUC) was 0.654, with the optimal cut-off value −0.37 Pa/mm. The largest AUC was recognised for combined WSS and WSSG (AUC = 0.671). Our data confirmed that aneurysms tend to form near the bifurcation apices in regions of high WSS values accompanied by positive WSSG. Conclusions The development of IAs is determined by an independent effect of haemodynamic factors. High WSS impacts MCA aneurysm formation, while a positive WSSG mainly promotes this process.

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“…The MCA is also a location of saccular cerebral aneurysms [3][4]. Aneurysms of the MCA are most often located within its main trunk division where hemodynamic stress is greatest [4][5].…”

Section: Introductionmentioning

confidence: 99%

Morphometric study of the bilateral middle cerebral arteries in patients with a unilateral aneurysm

Siedlecki¹,

Nowak²,

Śniegocki³

et al. 2021

Eur J Trans Clin Med

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Morphological and Hemodynamic Risk Factors for Middle Cerebral Artery Aneurysm: a Case-Control Study of 190 Patients

Cited by 22 publications

References 38 publications

Morphometry of Cerebral Arterial Bifurcations Harbouring Aneurysms: A Case-Control Study On 253 Patients

Morphometry of Cerebral Arterial Bifurcations Harbouring Aneurysms: A Case-Control Study On 253 Patients

Wall shear stress gradient is independently associated with middle cerebral artery aneurysm development: a case-control CFD patient-specific study based on 77 patients

Morphometric study of the bilateral middle cerebral arteries in patients with a unilateral aneurysm

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