Presence of Anterior Communicating Artery Aneurysm Is Associated With Age, Bifurcation Angle, and Vessel Diameter

Zhang, Xue‐Jing; Gao, Bu-Lang; Hao, Wei-Li; Wu, Song-Shi; Zhang, Donghai

doi:10.1161/strokeaha.117.019701

Cited by 64 publications

(54 citation statements)

References 24 publications

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“…3D rotational angiography, MRA, CTA) dealing with the problem of bifurcation angle morphology showed that wide bifurcation angle constitutes a significant risk factor for aneurysm formation. Those studies included the bifurcations which are generally considered to be predisposed for aneurysm development: ACoA complex 8,16,[34][35][36] , BA 14,29,37 and MCA 30,38 . Our findings are consistent with the results of the studies mentioned above; our present study showed that Φ 1 , Φ 2 and α angles in aneurysmal MCA bifurcations were significantly wider than in contralateral and control bifurcations.…”

Section: Discussionmentioning

confidence: 99%

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

Kaspera

Ćmiel-Smorzyk

Wolański

et al. 2020

Sci Rep

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this study analyzed morphometric and hemodynamic parameters of aneurysmal and non-aneurysmal middle cerebral artery (McA) bifurcations and their relationship with optimal values derived from the principle of minimum work (PMW). The study included 96 patients with MCA aneurysm and 94 controls. Aneurysm patients presented with significantly higher values of the radius and cross-sectional area of the McA trunk, angle between the post-bifurcation branches (α angle) and volume flow rate (VFR) and had significantly lower values of junction exponent and pulsatility index than the controls. The Φ 1 and Φ 2 angles (angles between the MCA trunk axis and the larger and smaller branch, respectively) and α angle in all groups were significantly larger than the optimal PMW-derived angles. The most important independent predictors of MCA aneurysm were junction exponent (odds ratio, OR = 0.42), α angle (oR = 1.07) and VFR (OR = 2.36). Development of cerebral aneurysms might be an independent effect of abnormalities in hemodynamic and morphometric factors. The risk of aneurysm increased proportionally to the deviation of morphometric parameters of the bifurcation from their optimal pMWderived values. The role of bifurcation angle in aneurysm development needs to be explained in future research as the values of this parameter in both aneurysm patients and non-aneurysmal controls in were scattered considerably around the pMW-derived optimum.

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Section: Discussionmentioning

confidence: 99%

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

Kaspera

Ćmiel-Smorzyk

Wolański

et al. 2020

Sci Rep

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“…The posterior vasculature is more capable of arterial remodeling compared to the anterior vasculature [ 11 ]. The branching site is more vulnerable to hemodynamic stress because of the deflection and oscillation of blood flow [ 12 ], and cerebral aneurysms occur preferentially at arterial bifurcations.…”

Section: Structure Of the Cerebral Arterymentioning

confidence: 99%

“…Cerebral aneurysms preferentially occur at the anterior communicating artery, the posterior communicating artery, the middle cerebral artery bifurcation, and the basilar artery bifurcation where local shear stress is greatest on the arterial wall [ 12 , 29 ]. Blood flow at the arterial junctions, the bifurcations with wider bifurcation angles, or abrupt vascular angles are the most turbulent, and the shear stresses in these areas are the greatest.…”

Section: Pathophysiology Of a Cerebral Aneurysmmentioning

confidence: 99%

New Pathophysiological Considerations on Cerebral Aneurysms

Jung

2018

Neurointervention

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Cerebral aneurysm is a common cerebrovascular disease that is sometimes complicated by rupture or an enlarged mass. We are now aggressively evaluating and managing unruptured cerebral aneurysms based on a significant concern for the high morbidity and mortality related to its associated complications. However, the actual rupture rate is very low and the diagnostic and treatment modalities are expensive and invasive, which may lead to unnecessary costs and potential medical complications. This disproportionate situation is related to a poor understanding of the natural course and pathophysiology of cerebral aneurysms. In consideration of the concept that not all cerebral aneurysms must be removed, we need to examine their course and progression more accurately. Cerebral aneurysms may follow a variety of pathophysiological scenarios over their lifetime, from formation to growth and rupture. The disease course and the final outcome can differ depending on the timing and intensity of the pathological signals acting on the cerebral vessel wall. We should delineate a method of predicting the stability and risk of rupture of the lesion based on a comprehensive knowledge of the vessel wall integrity. This review deals with the basic knowledge and advanced concepts underlying the pathophysiology of cerebral aneurysms.

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“…In fact, there are several publications that identify vessel diameters of daughter vessels as well as asymmetry in bifurcations as a risk factor for aneurysm rupture. [28,30] In contrast, other studies could not confirm this correlation between the distal vascular diameter or asymmetries and the risk of rupture. [6,13] In general, aneurysms of the posterior region are associated with an increased risk of rupture [10,15,25] and are also significantly associated with worse clinical outcomes, independent of the treatment modality.…”

Section: Introductionmentioning

confidence: 82%

“…[16] The surrounding vasculature was of particular interest in this case because their anatomical changes can demonstrably influence the local flow dynamics. [3,23] Recent studies revealed a wider bifurcation angle, including the medial cerebral artery (MCA) [1], the anterior cerebral artery (ACA) [28], and the basilar artery (BA) [29], can alternate the flow dynamics and promote the formation of local aneurysms. In basilar tip aneurysms (BTAs), an increased posterior cerebral artery (PCA) angle has been reported to be associated with the risk of aneurysm rupture.…”

Section: Introductionmentioning

confidence: 99%

Asymmetry of P1 and vertebral arteries is not related to basilar tip aneurysm development or rupture

Hofmann

Fischer

et al. 2020

Acta Neurochir

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Objective Lately, morphological parameters of the surrounding vasculature aside from aneurysm size, specific for the aneurysm location, e.g., posterior cerebral artery angle for basilar artery tip aneurysms, could be identified to correlate with the risk of rupture. We examined further image-based morphological parameters of the aneurysm surrounding vasculature that could correlate with the growth or the risk of rupture of basilar artery tip aneurysms. Methods Data from 83 patients with basilar tip aneurysms (27 not ruptured; 56 ruptured) and 100 control patients were assessed (50 without aneurysms and 50 with aneurysms of the anterior circle of Willis). Anatomical parameters of the aneurysms were assessed and analyzed, as well as of the surrounding vasculature, namely the asymmetry of P1 and the vertebral arteries. Results Patients with basilar tip aneurysm showed no significant increase in P1 or vertebral artery asymmetry compared with the control patients or patients with aneurysms of the anterior circulation, neither was there a significant difference in asymmetry between cases with ruptured and unruptured aneurysms. Furthermore, we observed no significant correlations between P1 asymmetry and the aneurysm size or number of lobuli in the aneurysms. Conclusion We observed no significant difference in aneurysm size, rupture, or lobulation associated with P1 or vertebral artery (surrounding vasculature) asymmetry. Therefore, the asymmetry of the surrounding vessels does not seem to be a promising morphological parameter for the evaluation of probability of rupture and growth in basilar tip aneurysms in future studies.

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Presence of Anterior Communicating Artery Aneurysm Is Associated With Age, Bifurcation Angle, and Vessel Diameter

Abstract: The presence of Acom aneurysm is significantly associated with patient age, wider angles of the anterior cerebral artery bifurcation, and smaller vascular diameter of the anterior communicating complex.

Cited by 64 publications

References 24 publications

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

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

New Pathophysiological Considerations on Cerebral Aneurysms

Asymmetry of P1 and vertebral arteries is not related to basilar tip aneurysm development or rupture

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