REMOVED: The Optimality Principle Decreases Hemodynamic Stresses for Aneurysm Initiation at Anterior Cerebral Artery Bifurcations

Zhang, Xue‐Jing; Li, Conghui; Hao, Wei-Li; Zhang, Donghai; Gao, Bu-Lang

doi:10.1016/j.wneu.2018.09.112

Cited by 13 publications

(23 citation statements)

References 30 publications

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“…Sampling analysis of the hemodynamic parameters in the longitudinal line on the bifurcation apex wall with virtual aneurysm removal demonstrated that the total pressure was the greatest but the other parameters (dynamic pressure, WSS, vorticity and strain rate) were the least at the direct flow impinging center, which confirmed previous findings 8 , 10 , 11 , 23 . As blood flowed distally towards branching arteries, the total pressure decreased quickly while the other hemodynamic parameters increased rapidly to reach the peak at the branching arteries.…”

Section: Discussionsupporting

confidence: 88%

“…In our study, we used some virtual techniques to remove the aneurysm for restoring the arterial bifurcation morphology to the state before aneurysm formation. Virtual removal of cerebral aneurysms has been applied by many authors in the cerebral aneurysm research for investigating hemodynamic stresses before and after aneurysm formation 8 , 10 , 11 , 23 , 36 – 38 , including researchers from our lab 8 , 10 , 11 , 23 . This is because a saccular cerebral aneurysm is only a localized pathological outpouching of a weakened arterial wall with local disruption of elastic lamina, apoptosis of medial smooth and inflammatory cell infiltration 39 , 40 .…”

Section: Discussionmentioning

confidence: 99%

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Cerebral aneurysms at major arterial bifurcations are associated with the arterial branch forming a smaller angle with the parent artery

Gao

Hao

et al. 2022

Sci Rep

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Currently, the relationship of bifurcation morphology and aneurysm presence at the major cerebral bifurcations is not clear. This study was to investigate cerebral arterial bifurcation morphology and accompanied hemodynamic stresses associated with cerebral aneurysm presence at major cerebral arterial bifurcations. Cerebral angiographic data of major cerebral artery bifurcations of 554 anterior cerebral arteries, 582 internal carotid arteries, 793 middle cerebral arteries and 195 basilar arteries were used for measurement of arterial diameter, lateral and bifurcation angles and aneurysm deviation. Hemodynamic stresses were analyzed using computational fluid dynamic simulation. Significantly (P < 0.001) more aneurysms deviated toward the smaller branch and the smaller lateral angle than towards the larger branch and larger lateral angle at all four major bifurcations. At the flow direct impinging center, the total pressure was the greatest while the dynamic pressure, wall shear stress (WSS), vorticity and strain rate were the least. Peak 1 and Peak 2 were located on the branch forming a smaller and larger angle with the parent artery, respectively. The dynamic pressure (175.4 ± 18.6 vs. 89.9 ± 7.6 Pa), WSS (28.9 ± 7.4 vs. 15.7 ± 5.3 Pa), vorticity (9874.6 ± 973.4 vs. 7237.8 ± 372.7 1/S), strain rate (9873.1 ± 625.6 vs. 7648.3 ± 472.5 1/S) and distance (1.9 ± 0.8 vs. 1.3 ± 0.3 mm) between the peak site and direct flow impinging center were significantly greater at Peak 1 than at Peak 2 (P < 0.05 or P < 0.01). Moreover, aneurysms deviation and Peak 1 were always on the same side. In conclusion, the branch forming a smaller angle with the parent artery is associated with abnormally enhanced hemodynamic stresses to initiate an aneurysm at the bifurcation apex.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Cerebral aneurysms at major arterial bifurcations are associated with the arterial branch forming a smaller angle with the parent artery

Gao

Hao

et al. 2022

Sci Rep

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“…Murray used the PMW to predict vessel diameters and bifurcation angles in a theoretical vascular tree that is ideal for minimising the energy essential for ensuring blood ow continuity (15, 16). Murray's theoretical assumptions about the structure of the vascular network were con rmed by angiographic studies that demonstrated that the dimensions of various human blood vessels (17, 18), including intracranial arteries (19), were consistent with the theoretical optimal values imposed by the PMW.Based on the current reports, deviations in the geometry of intracranial arterial bifurcations predisposed to cerebral aneurysms, which are different from the PMW, may be a key determinant for the formation of aneurysms (14,20,21). Nevertheless, the conclusions from these reports are still inconclusive.…”

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confidence: 59%

“…Based on the current reports, deviations in the geometry of intracranial arterial bifurcations predisposed to cerebral aneurysms, which are different from the PMW, may be a key determinant for the formation of aneurysms (14,20,21). Nevertheless, the conclusions from these reports are still inconclusive.…”

Section: Discussionmentioning

confidence: 90%

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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“…More frequent aneurysm development at the AComA junction can be explained by the disruption of flow imbalance secondary to complex morphology and increased nonhomogeneous hemodynamic stress 11–14 . It is a well‐known fact that AComA aneurysms have higher rupture risk than other cerebral aneurysms 1,15,16 .…”

Section: Discussionmentioning

confidence: 99%

Anterior communicating artery aneurysms: Nonmodifiable morphological parameters associated with rupture risk

Soylu

Uzunkaya

Akan

2021

Journal of Neuroimaging

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Background and Purpose The aim of this study was to investigate the relationship between arterial morphological parameters and the rupture risk of anterior communicating artery (AComA) aneurysms. Methods A hospital database was retrospectively reviewed to identify patients with AComA aneurysms. Morphologic parameters were evaluated on the 3‐dimensional computed tomography angiograms. The patients were divided into two groups as ruptured and unruptured. Patient age, sex, morphological parameters such as aneurysm height and weight, neck diameter, aspect ratio (AR), size ratio (SR), bifurcation angle, aneurysm shape, and diameters of the artery were statistically compared between two groups. Results Ninety‐five AComA aneurysms were analyzed in this study (60 ruptured and 35 unruptured). The aneurysm neck size (p = .005) and the diameter of the A1 segment of the ipsilateral anterior cerebral artery (i‐A1) were smaller in the ruptured group than in the unruptured group (p = .001), but AR (p = .001) was higher. The number of patients with irregular shape aneurysm were higher in the ruptured group (p = .006). There was no significant difference between the two groups in terms of age, sex, aneurysm height and weight, bifurcation angle, and SR. Univariate logistic regression analysis showed that i‐A1 segment diameter (odds ratio [OR]: –2.070, confidence interval [CI]: 0.030‐0.531, p = .005), aneurysm neck diameter (OR: –0.409, CI: 0.491‐0.899, p = .008), irregular shape (OR: 1.197, CI: 1.382‐7.929, p = .007), and AR (OR: 0.880, CI: 1.315‐4.417, p = .004) were significantly correlated with ruptured status. Multivariate regression analysis demonstrated that aneurysm neck diameter (OR: –0.457, CI: 0.410‐0.977, p = .039) was the only independent variable for rupture. Conclusion AComA aneurysm rupture is more likely to occur in aneurysms with smaller i‐A1 segment diameter, smaller aneurysm neck diameter, irregular aneurysm shape, and higher AR. Aneurysm neck diameter may be a more important determinant for rupture prediction.

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REMOVED: The Optimality Principle Decreases Hemodynamic Stresses for Aneurysm Initiation at Anterior Cerebral Artery Bifurcations

Cited by 13 publications

References 30 publications

Cerebral aneurysms at major arterial bifurcations are associated with the arterial branch forming a smaller angle with the parent artery

Cerebral aneurysms at major arterial bifurcations are associated with the arterial branch forming a smaller angle with the parent artery

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

Anterior communicating artery aneurysms: Nonmodifiable morphological parameters associated with rupture risk

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