Sex differences in intracranial arterial bifurcations

Lindekleiv, Haakon; Valen‐Sendstad, Kristian; Morgan, M.; Mardal, Kent‐André; Faulder, Kenneth; Magnus, Jeanette H.; Waterloo, Knut; Romner, Bertil; Ingebrigtsen, Tor

doi:10.1016/j.genm.2010.03.003

Cited by 57 publications

(53 citation statements)

References 34 publications

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“…22 It is also generally accepted that geometrical aberrations are predisposWidening of the basilar bifurcation angle: association with presence of intracranial aneurysm, age, and female sex ing factors for vascular diseases, including atherosclerosis and IAs. 6,11,14,15,24 Wider bifurcation angles have been associated with aneurysm presence 11 and a particular hemodynamic environment at the bifurcation apex characterized by a wider stagnation area 7 of low pressure and WSS, which may allow aneurysms in these locations to grow larger than those located at bifurcations with narrow angles. 10 Basilar artery (BA) aneurysms account for 5%-8% of all IAs.…”

Section: ©Aans 2014mentioning

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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Section: ©Aans 2014mentioning

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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“…Horikoshi et al, 16 who studied 131 patients with cerebral aneurysms using MR angiography, demonstrated that anterior communicating artery aneurysms are significantly related to Type A anatomy (no visualization of a unilateral A 1 segment), which is more common in men, whereas ICA aneurysms are associated with Type P anatomy (presence of a fetal type of posterior cerebral artery that was continuously delineated from the ICA through the posterior communicating artery), which is more common in women. 16 In addition, Lindekleiv et al, 27 in a study using computational fluid dynamics, showed that compared with men, women have disproportionately smaller vessel diameters, greater blood flow velocities, and higher wall shear stress at ICA bifurcations, which increases the risk of aneurysm formation.…”

Section: 3134mentioning

confidence: 99%

Subarachnoid hemorrhage and the female sex: analysis of risk factors, aneurysm characteristics, and outcomes

Hamdan

Barnes

Mitchell

2014

JNS

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Object The pathophysiology of aneurysmal subarachnoid hemorrhage (aSAH) is unclear. Sex may play a role in the outcome of patients with aSAH. Methods The authors retrospectively identified 617 patients with aSAH (April 2005 to February 2010) and analyzed sex differences in risk factors (age, hypertension, smoking, alcohol consumption, and family history), admission-related factors (World Federation of Neurosurgical Societies grade and admission delay), aneurysm characteristics (site, side, location, and multiplicity), and outcomes (treatment modalities [coiling/clipping/both/conservative], complications [vasospasm and hydrocephalus], length of stay, and modified Rankin Scale score at 3 months). Results The female patients with aSAH were older than the male patients (mean age 56.6 vs 51.9 years, respectively, p < 0.001), and more women than men were ≥ 55 years old (56.2% vs 40.4%, respectively, p < 0.001). Women exhibited higher rates of bilateral (6.8% vs 2.6%, respectively, p < 0.05), multiple (11.5% vs 5.2%, respectively, p < 0.05), and internal carotid artery (ICA) (36.9% vs 17.5%, respectively, p < 0.001) aneurysms and a lower rate of anterior cerebral artery aneurysms (26.3% vs 44.8%, respectively, p < 0.001) than the men, but no side differences were noted. There were no sex differences in risk factors, admission-related factors, or outcome measures. For both sexes, outcomes varied according to aneurysm location, with odds ratios for a poor outcome of 1.62 (95% CI 0.91–2.86, p = 0.1) for middle cerebral artery, 2.41 (95% CI 1.29–4.51, p = 0.01) for ICA, and 2.41 (95% CI 1.29–4.51, p = 0.006) for posterior circulation aneurysms compared with those for anterior cerebral artery aneurysms. The odds ratio for poor outcome (modified Rankin Scale score of 4–6) in women compared with men after adjusting for significant prognostic factors was 0.71 (95% CI 0.45–1.11, p > 0.05). Conclusions The overall outcomes after aSAH between women and men are similar.

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“…While variability regarding arterial characteristics (e.g., wall thickness, vessel diameter) between populations (sex, ethnicity) has been directly examined in some arterial systems (Eden et al 2008, Lindekleiv et al 2010, Müller et al 1991, Schulz and Rothwell 2001, very little has been reported contrasting the differences in ECA branching pattern between sex and side. This study assessed the origin of the caudal four ECA branches to compare the anatomy of males versus females, and right versus left neck.…”

Section: Introductionmentioning

confidence: 99%

Variation in the Caudal Branches of the External Carotid Artery: Comparison of Sex and Side

Heltzel

Jelínek

Jaynes

2015

MRAJ

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Background:The branching pattern of vessels emerging from the external carotid artery varies considerably. Knowledge of this variation is critical for clinicians who perform neck procedures. This study assessed the origin of the four primary caudal branches of the external carotid artery (superior thyroid, lingual, facial, and occipital arteries) with regard to sex and side. The position of common carotid artery bifurcation was also analyzed with regard to sex and side. Methods: The carotid arterial system of 79 cadavers from the eastern United States (37 male, 42 female) was dissected bilaterally. The position of carotid bifurcation relative to a midpoint between the suprasternal notch and mastoid process was measured with digital fractional calipers. Origin of the caudal branches was determined and the distance from the carotid bifurcation measured. Results: On the right, the superior thyroid artery emerged from the carotid bifurcation/external carotid more frequently than it did from the common carotid (67% and 31%, respectively); however, on the left, it emerged more frequently from the common carotid (57% and 43%, respectively) (p = 0.003). No side-dependent differences were observed for the remaining three caudal branches. The occipital artery emerged below the origin of the facial artery more frequently than at/above (55% and 44%, respectively). No significant differences were found for the origin of the caudal four branches with regard to sex. There was no significant difference in the location of the carotid bifurcation with regard to sex or side. Conclusions: The origin of the superior thyroid artery differed when comparing neck side, while the origin of the occipital artery frequently emerged caudal to that of the facial artery. Both findings are inconsistent with most anatomical atlases. The positions of the carotid bifurcation as well as the origin of the remaining caudal branches were no different with regard to either parameter.

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Sex differences in intracranial arterial bifurcations

Cited by 57 publications

References 34 publications

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

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

Subarachnoid hemorrhage and the female sex: analysis of risk factors, aneurysm characteristics, and outcomes

Variation in the Caudal Branches of the External Carotid Artery: Comparison of Sex and Side

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