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van der Sluijs PM, Su R, Cornelissen SAP, van Es ACGM, Lycklama A Nijeholt G, Roozenbeek B, van Doormaal PJ, Hofmeijer J, van der Lugt A, van Walsum T. Clinical consequence of vessel perforations during endovascular treatment of acute ischemic stroke. Neuroradiology 2024; 66:237-247. [PMID: 38010403 DOI: 10.1007/s00234-023-03246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Endovascular treatment (EVT) of acute ischemic stroke can be complicated by vessel perforation. We studied the incidence and determinants of vessel perforations. In addition, we studied the association of vessel perforations with functional outcome, and the association between location of perforation on digital subtraction angiography (DSA) and functional outcome, using a large EVT registry. METHODS We included all patients in the MR CLEAN Registry who underwent EVT. We used DSA to determine whether EVT was complicated by a vessel perforation. We analyzed the association with baseline clinical and interventional parameters using logistic regression models. Functional outcome was measured using the modified Rankin Scale at 90 days. The association between vessel perforation and angiographic imaging features and functional outcome was studied using ordinal logistic regression models adjusted for prognostic parameters. These associations were expressed as adjusted common odds ratios (acOR). RESULTS Vessel perforation occurred in 74 (2.6%) of 2794 patients who underwent EVT. Female sex (aOR 2.0 (95% CI 1.2-3.2)) and distal occlusion locations (aOR 2.2 (95% CI 1.3-3.5)) were associated with increased risk of vessel perforation. Functional outcome was worse in patients with vessel perforation (acOR 0.38 (95% CI 0.23-0.63)) compared to patients without a vessel perforation. No significant association was found between location of perforation and functional outcome. CONCLUSION The incidence of vessel perforation during EVT in this cohort was low, but has severe clinical consequences. Female patients and patients treated at distal occlusion locations are at higher risk.
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Affiliation(s)
- P Matthijs van der Sluijs
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - R Su
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - S A P Cornelissen
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A C G M van Es
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - B Roozenbeek
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - P J van Doormaal
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J Hofmeijer
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
| | - A van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - T van Walsum
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Saal-Zapata G, Walker M, Cervantes-Medina R, Rodríguez-Varela R. Three-Dimensional Morphometric Analysis of Anterior Cerebral Circulation Aneurysms. Int J Angiol 2024; 33:22-28. [PMID: 38352634 PMCID: PMC10861294 DOI: 10.1055/s-0043-1774740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
This article assesses the association between anterior circulation morphometry and the presence of intracranial aneurysm using three-dimensional rotational angiography (3DRA). A retrospective analysis at a Peruvian academic medical center between December 2018 and February 2020 identified 206 patients with unruptured intracranial aneurysms and matched controls who underwent 3DRA. Angiographic images were obtained per standard of care, and measurements of the vasculature were performed using 3DRA vascular automated software. A total of 163 aneurysms and 43 control angiograms were evaluated. Women represented 82.5% of the cases and the mean age was 55.9 years (standard deviation ± 14.2). In multivariate analysis, five specific features were found to be statistically significant predictors for presence of an anterior circulation aneurysm: female sex (odds ratio [OR] = 2.71; p = 0.048), C-shape of the middle cerebral artery (MCA) (OR = 2.73; p = 0.018), distal internal carotid artery (ICA) diameter (OR = 3.42; p = 0.012), ICA bifurcation angle (OR = 1.02; p = 0.036), and length of the carotid siphon (OR = 1.08; p = 0.047). Features detected on 3DRA suggest morphological characteristics of the ICA and MCA may be predictive for intracranial aneurysm. Our findings build from prior reports by demonstrating five specific patient and imaging features associated with anterior circulation aneurysms. While 3DRA is the standard of care in many settings, medical centers with resource limitations may not have access to this technique. The demographic and morphological features identified in our study may have correlates that if detected on contrast computed tomography or magnetic resonance imaging studies, may be used to help screen for a higher level of care in select patients.
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Affiliation(s)
- Giancarlo Saal-Zapata
- Department of Neurosurgery, Endovascular Neurosurgery Service, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, La Victoria, Lima, Perú
| | - Melanie Walker
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Rosa Cervantes-Medina
- Department of Radiology, Interventional Radiology Service, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, La Victoria, Lima, Perú
| | - Rodolfo Rodríguez-Varela
- Department of Neurosurgery, Endovascular Neurosurgery Service, Hospital Nacional Guillermo Almenara Irigoyen-EsSalud, La Victoria, Lima, Perú
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Urvi S, Suman V, Subathra A. Assessment of morphometric parameters of middle cerebral artery using CT angiography in a tertiary care hospital. Surg Radiol Anat 2023:10.1007/s00276-023-03148-1. [PMID: 37269412 DOI: 10.1007/s00276-023-03148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 04/12/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Middle cerebral artery (MCA) favors secondaries and emboli deposition. Also, with an increase in incidence of MCA aneurysms, majorly at the M1 division point, actual standardized measurement of MCA is necessary. Thus, main aim of the study is assessment of the MCA morphometry using CT Angiography in Indian population. METHODS CT cerebral Angiography datasets of 289 patients (180 males and 109 females) were assessed for the MCA morphometry (Average age - 49.29 ± 16.16 years, Range- 11 to 85 years). The cases involving aneurysms and infarcts were excluded. The total length of MCA, length of M1 segment and diameter were measured and the results were statistically analysed. RESULTS The mean total length of MCA, length of M1 segment and diameter were 24.02 ± 1.22 mm, 14.32 ± 1.27 mm, 3.33 ± 0.62 mm, respectively. The mean length of M1 segment on the right and left sides was 14.19 ± 1.39 mm and 14.44 ± 1.12 mm, respectively and the difference was statistically significant (p ≤ 0.05). The mean diameter on the right and left sides was 3.32 ± 0.62 mm and 3.33 ± 0.62 mm, respectively and the difference was not statistically significant (p = 0.832). The M1 segment length was maximum in patients over 60 years and diameter was maximum in young patients (20-40 years). The mean length of M1 segment in early bifurcation (4.4 ± 0.65 mm), bifurcation (14.32 ± 1.27 mm) and trifurcation (14.15 ± 1.43 mm) was also noted. CONCLUSION The MCA measurements will be useful for surgeons to minimize errors in handling cases of intracranial aneurysms or infarcts and provide the best possible outcome to the patients.
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Affiliation(s)
- Sharma Urvi
- Department of Anatomy, AIIMS Raipur, Raipur, Chhattisgarh, India.
| | - Verma Suman
- Department of Anatomy, JIPMER, Puducherry, India
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Evaluation of Middle Cerebral Artery Symmetry: A Pilot Study for Clinical Application in Mechanical Thrombectomy. World Neurosurg 2022; 166:e980-e985. [PMID: 35964905 DOI: 10.1016/j.wneu.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/06/2022] [Accepted: 08/06/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Endovascular mechanical thrombectomy (MT) has now evolved to become the standard treatment for acute ischemic stroke due to large vessel occlusion. Arterial perforation is a potential complication of MT, and the risk of this event during blind crossing the occlusion site has been elucidated. The intracranial arterial system shows morphological structural symmetry, so we investigated the utility of the bilateral symmetry of the proximal middle cerebral artery (MCA) as a preprocedural evaluation to predict hidden running course distal to the thrombus. METHODS This study retrospectively analyzed 191 consecutive patients (mean age, 67.5 ± 15.5 years; 100 women) who underwent time-of-flight-magnetic resonance angiography in our institution. Four landmarks of the MCA were assessed: division pattern, early branching pattern, length, and course pattern. Each geometric property was compared between cerebral hemispheres. Frequencies of symmetry and symmetry breaking were assessed. RESULTS In 91% (bifurcation type, 87%; trifurcation type, 4%), branching patterns of the left and right M1 were symmetrical. Early frontal and/or temporal branches were observed in 31%, and the presence/absence of early branches was symmetrical in 70% cases. In 19%, M1 was classified as short M1, and classifications were identical between hemispheres in 74%. Running course of the M1 was symmetrical in 63%. Two or more parameters were symmetrical in 181 cases (95%). CONCLUSIONS The symmetry of bilateral M1-2 structures was demonstrated in most cases from the perspectives of 4 parameters. The MCA symmetry can predict the running course of the MCA before crossing the occlusion site and shows potential benefits for neurointerventionalists.
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Age-dependent Intracranial Artery Morphology in Healthy Children. Clin Neuroradiol 2021; 32:49-56. [PMID: 34427700 DOI: 10.1007/s00062-021-01071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Evaluation of intracranial artery morphology plays an important role in diagnosing a variety of neurovascular diseases. In addition to clinical symptoms, diagnosis currently relies on qualitative rather than quantitative evaluation of vascular imaging sequences, such as magnetic resonance angiography (MRA). However, there is a paucity of literature on normal arterial morphology in the pediatric population across brain development. We aimed to quantitatively assess normal, age-related changes in artery morphology in children. METHODS We performed retrospective analysis of pediatric MRA data obtained from a tertiary referral center. An MRA dataset from 98 children (49 boys/49 girls) aged 0.6-20 years (median = 11.5 years) with normal intracranial vasculature was retrospectively collected between 2011 and 2018. All arteries were automatically segmented to determine the vessel radius. Using an atlas-based approach, the average radius and density of arteries were measured in the three main cerebral vascular territories and the radius of five major arteries was determined at corresponding locations. RESULTS The radii of the major arteries as well as the average artery radius and density in the different vascular territories in the brain remained constant throughout childhood and adolescence (|r| < 0.369 in all cases). CONCLUSION This study presents the first automated evaluation of intracranial vessel morphology on MRA across childhood. Our results can serve as a framework for quantitative evaluation of cerebral vessel morphology in the setting of pediatric neurovascular diseases.
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Spiessberger A, Strange F, Gruter BE, Wanderer S, Casoni D, Gruber P, Diepers M, Remonda L, Fandino J, Añon J, Marbacher S. An endovascular assisted, nonocclusive cerebral bypass: a technical feasibility study in a rabbit model. J Neurosurg 2021; 134:1846-1851. [PMID: 32502997 DOI: 10.3171/2020.3.jns20334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/31/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Temporary parent vessel occlusion performed to establish a high-flow interpositional bypass carries the risk of infarcts. The authors investigated the feasibility of a novel technique to establish a high-flow bypass without temporary parent vessel occlusion in order to lower the risk of ischemic complications. METHODS In 10 New Zealand white rabbits, a carotid artery side-to-end anastomosis was performed under parent artery patency with a novel endovascular balloon device. Intraoperative angiography, postoperative neurological assessments, and postoperative MRI/MRA were performed to evaluate the feasibility and safety of the novel technique. RESULTS A patent anastomosis was established in 10 of 10 animals; 3 procedure-related complications occurred. No postoperative focal neurological deficits were observed. The MRI/MRA findings include no infarcts and bypass patency in 50% of the animals. CONCLUSIONS The authors demonstrated the feasibility of an endovascular assisted, nonocclusive high-flow bypass. Future refinement of the device and technique in an animal model is necessary to lower the complication rate and increase patency rates.
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Affiliation(s)
- Alexander Spiessberger
- 1Department of Neurosurgery, Kantonsspital Aarau
- 2Department of Biomedical Research, Cerebrovascular Research Group, University of Bern
| | - Fabio Strange
- 1Department of Neurosurgery, Kantonsspital Aarau
- 2Department of Biomedical Research, Cerebrovascular Research Group, University of Bern
| | - Basil Erwin Gruter
- 1Department of Neurosurgery, Kantonsspital Aarau
- 2Department of Biomedical Research, Cerebrovascular Research Group, University of Bern
| | - Stefan Wanderer
- 1Department of Neurosurgery, Kantonsspital Aarau
- 2Department of Biomedical Research, Cerebrovascular Research Group, University of Bern
| | - Daniela Casoni
- 3Department of Biomedical Research, Faculty of Medicine, University of Bern; and
| | - Philipp Gruber
- 4Division of Neuroradiology, Kantonsspital Aarau, Switzerland
| | - Michael Diepers
- 4Division of Neuroradiology, Kantonsspital Aarau, Switzerland
| | - Luca Remonda
- 4Division of Neuroradiology, Kantonsspital Aarau, Switzerland
| | - Javier Fandino
- 1Department of Neurosurgery, Kantonsspital Aarau
- 2Department of Biomedical Research, Cerebrovascular Research Group, University of Bern
| | - Javier Añon
- 4Division of Neuroradiology, Kantonsspital Aarau, Switzerland
| | - Serge Marbacher
- 1Department of Neurosurgery, Kantonsspital Aarau
- 2Department of Biomedical Research, Cerebrovascular Research Group, University of Bern
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Khatri R, Qureshi MA, Chaudhry MRA, Maud A, Vellipuram AR, Cruz-Flores S, Rodriguez GJ. The Angiographic Anatomy of the Sphenoidal Segment of the Middle Cerebral Artery and Its Relevance in Mechanical Thrombectomy. INTERVENTIONAL NEUROLOGY 2020; 8:231-241. [PMID: 32508905 DOI: 10.1159/000502545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 08/01/2019] [Indexed: 11/19/2022]
Abstract
Objective The middle cerebral artery (MCA) is the most commonly treated artery in mechanical thrombectomy stroke trials; however, there is no pragmatic agreement about the segmental anatomy and nomenclature utilized. It results in significant clinical-radiological dissociation and introduces bias in research trials. The purpose of the study is to review and compare angiographic anatomy with microsurgical anatomy literature of the MCA with emphasis on the discrepancy. Methodology Consecutive cerebral angiograms between January 2011 and March 2014 were retrospectively reviewed by endovascular surgical neuroradiologists. Information about the anatomy of the sphenoidal segment of the MCA classified as classic and non-classic pattern, the lenticulostriate artery takeoff pattern, and the course angulation of the sphenoidal segment were studied. Results A total of 500 patients, 886 cerebral angiograms, were reviewed. We found the classic pattern of the main trunk MCA bifurcation and a straight angulation course in less than half of the cases. The lenticulostriate arteries arose not only from the main trunk but also from its divisions in more than half of the cases. Conclusion It is important to corroborate our findings and to develop a pragmatic classification to accurately assess MCA occlusions from the radiological and clinical perspective.
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Affiliation(s)
- Rakesh Khatri
- Department of Neurology, Texas Tech University of Health Sciences Center, El Paso, Texas, USA
| | | | | | - Alberto Maud
- Department of Neurology, Texas Tech University of Health Sciences Center, El Paso, Texas, USA
| | | | - Salvador Cruz-Flores
- Department of Neurology, Texas Tech University of Health Sciences Center, El Paso, Texas, USA
| | - Gustavo Jose Rodriguez
- Department of Neurology, Texas Tech University of Health Sciences Center, El Paso, Texas, USA
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Liu L, Huo C, Sun H, Yang H, Zhang R, Wang L, Xia Z. Vascular Morphology has No Direct Relationship with Atherosclerotic Plaque Burden in Patients with Symptomatic Middle Cerebral Artery Stenosis. Curr Neurovasc Res 2019; 16:224-231. [PMID: 31258086 DOI: 10.2174/1567202616666190618122746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The vascular morphology and the characteristics of atherosclerotic plaques in the middle cerebral artery (MCA) have not been fully studied with high-resolution magnetic resonance imaging (HR-MRI). OBJECTIVE HR-MRI was applied to investigate vascular morphology and atherosclerotic plaque in patients with symptomatic MCA stenosis. MATERIALS AND METHODS A total of 343 patients with symptomatic MCA stenosis were enrolled in this study. All the patients were examined by HR-MRI to analyze the morphology of MCA and the M1 segment (MCA-M1), the characteristics and the location of the plaques. RESULTS The proportion of L-shaped MCA-M1 decreased, while the proportion of S-shaped MCAM1 increased with age. The anterior plaques were the most common in all the patients. The superior plaques were relatively common in patients with L-shaped and U-shaped MCA-M1, while the inferior plaques were relatively common in patients with inverted U-shaped and S-shaped MCAM1. Among all the plaques, the majority were isointense or heterogeneous. The MCA-M1 morphology had no direct relationship with the common risk factors of atherosclerosis and the clinical outcomes of the patients after 12 months of follow up. CONCLUSION The morphology of MCA-M1 is not directly related to the plaque burden or the degree of stenosis in patients with symptomatic MCA stenosis. The morphology of MCA-M1 is not associated with the risk factors of atherosclerosis, or the clinical outcomes of the patients.
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Affiliation(s)
- Lu Liu
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, China
| | - Chengju Huo
- Department of Neurology, The Third People's Hospital of Liaocheng, Liaocheng, Shandong, 252000, China
| | - Hao Sun
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, China
| | - Hua Yang
- Department of Neurology, The Third People's Hospital of Liaocheng, Liaocheng, Shandong, 252000, China
| | - Rui Zhang
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, China
| | - Lexin Wang
- Department of Cardiology, Liaocheng People's Hospital, Liaocheng, Shandong, 252000, China.,School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Zhangyong Xia
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, Shandong 252000, China
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Chen L, Sun J, Hippe DS, Balu N, Yuan Q, Yuan I, Zhao X, Li R, He L, Hatsukami TS, Hwang JN, Yuan C. Quantitative assessment of the intracranial vasculature in an older adult population using iCafe. Neurobiol Aging 2019; 79:59-65. [PMID: 31026623 PMCID: PMC6591051 DOI: 10.1016/j.neurobiolaging.2019.02.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/04/2019] [Accepted: 02/28/2019] [Indexed: 01/11/2023]
Abstract
Comprehensive quantification of intracranial artery features may help us assess and understand variations of blood supply during brain development and aging. We analyzed vasculature features of 163 participants (age 56-85 years, mean of 71) from a community study to investigate if any of the features varied with age. Three-dimensional time-of-flight magnetic resonance angiography images of these participants were processed in IntraCranial artery feature extraction technique (a recently developed technique to obtain quantitative features of arteries) to divide intracranial vasculatures into anatomical segments and generate 8 morphometry and intensity features for each segment. Overall, increase in age was found negatively associated with number of branches and average order of intracranial arteries while positively associated with tortuosity, which remained after adjusting for cardiovascular risk factors. The associations with number of branches and average order were consistently found between 3 main intracranial artery regions, whereas the association with tortuosity appeared to be present only in middle cerebral artery/distal arteries. The combination of time-of-flight magnetic resonance angiography and IntraCranial artery feature extraction technique may provide an effective way to study vascular conditions and changes in the aging brain.
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Affiliation(s)
- Li Chen
- Department of Electrical Engineering, University of Washington, Seattle, WA, USA
| | - Jie Sun
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Daniel S Hippe
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Niranjan Balu
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Quan Yuan
- Department of Neurology, Xuanwu hospital, Capital Medical University, Beijing, China
| | | | - Xihai Zhao
- Biomedical Engineering, Tsinghua University, Beijing, China
| | - Rui Li
- Biomedical Engineering, Tsinghua University, Beijing, China
| | - Le He
- Biomedical Engineering, Tsinghua University, Beijing, China
| | | | - Jenq-Neng Hwang
- Department of Electrical Engineering, University of Washington, Seattle, WA, USA
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA, USA.
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Peter R, Emmer BJ, van Es AC, van Walsum T. Quantitative Analysis of Geometry and Lateral Symmetry of Proximal Middle Cerebral Artery. J Stroke Cerebrovasc Dis 2017; 26:2427-2434. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/24/2017] [Accepted: 05/30/2017] [Indexed: 12/25/2022] Open
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Estevão IA, Camporeze B, Araujo Jr ASD, Nery B, Antunes ÁCM, Smith TR, Aguiar PHPD. Middle cerebral artery aneurysms: aneurysm angiographic morphology and its relation to pre-operative and intra-operative rupture. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:523-532. [DOI: 10.1590/0004-282x20170082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/30/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective Correlate the middle cerebral artery bifurcation aneurysm morphology with the pre-operative and intra-operative risk of rupture. Methods Forty patients with 46 middle cerebral artery bifurcation aneurysms were treated microsurgically by the same surgeon. Aneurysms were classified according to shape and the Fisher test was applied to analyze the effect of morphology on the pre-operative and intra-operative rupture. Results Pre-operative and intra-operative ruptures were observed in 8/46 patients (17.4%) and 14/46 patients (30.4%) respectively. Thirty-two cases (69.6%) had no symptoms postoperatively, modified Rankin score (MRS) of 0; 6.5% had MRS of 1 (no significant disability); 13% had MRS of 2 (slight disability); 4.3% had moderately severe disability (MRS of 4); and there were 3 deaths (6.5%) post-operatively. The morphology was not directly related to the rupture rate. Conclusion In general, ruptures are not affected by the morphology or the studied variables. Larger series are needed to validate these outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Paulo Henrique Pires de Aguiar
- Hospital Santa Paula, Brasil; Universidade Federal do Rio Grande do Sul, Brasil; Pontifícia Universidade Católica de São Paulo, Brasil
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Han J, Qiao H, Li X, Li X, He Q, Wang Y, Cheng Z. The three-dimensional shape analysis of the M1 segment of the middle cerebral artery using MRA at 3T. Neuroradiology 2014; 56:995-1005. [DOI: 10.1007/s00234-014-1414-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022]
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Wright SN, Kochunov P, Mut F, Bergamino M, Brown KM, Mazziotta JC, Toga AW, Cebral JR, Ascoli GA. Digital reconstruction and morphometric analysis of human brain arterial vasculature from magnetic resonance angiography. Neuroimage 2013; 82:170-81. [PMID: 23727319 PMCID: PMC3971907 DOI: 10.1016/j.neuroimage.2013.05.089] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 01/26/2023] Open
Abstract
Characterization of the complex branching architecture of cerebral arteries across a representative sample of the human population is important for diagnosing, analyzing, and predicting pathological states. Brain arterial vasculature can be visualized by magnetic resonance angiography (MRA). However, most MRA studies are limited to qualitative assessments, partial morphometric analyses, individual (or small numbers of) subjects, proprietary datasets, or combinations of the above limitations. Neuroinformatics tools, developed for neuronal arbor analysis, were used to quantify vascular morphology from 3T time-of-flight MRA high-resolution (620 μm isotropic) images collected in 61 healthy volunteers (36/25 F/M, average age=31.2 ± 10.7, range=19-64 years). We present in-depth morphometric analyses of the global and local anatomical features of these arbors. The overall structure and size of the vasculature did not significantly differ across genders, ages, or hemispheres. The total length of the three major arterial trees stemming from the circle of Willis (from smallest to largest: the posterior, anterior, and middle cerebral arteries; or PCAs, ACAs, and MCAs, respectively) followed an approximate 1:2:4 proportion. Arterial size co-varied across individuals: subjects with one artery longer than average tended to have all other arteries also longer than average. There was no net right-left difference across the population in any of the individual arteries, but ACAs were more lateralized than MCAs. MCAs, ACAs, and PCAs had similar branch-level properties such as bifurcation angles. Throughout the arterial vasculature, there were considerable differences between branch types: bifurcating branches were significantly shorter and straighter than terminating branches. Furthermore, the length and meandering of bifurcating branches increased with age and with path distance from the circle of Willis. All reconstructions are freely distributed through a public database to enable additional analyses and modeling (cng.gmu.edu/brava).
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Affiliation(s)
- Susan N. Wright
- Krasnow Inst. for Advanced Study, George Mason Univ., Fairfax, VA, USA
| | - Peter Kochunov
- Univ. of Texas, Health Science Center in San Antonio, USA
| | - Fernando Mut
- Center for Computational Fluid Dynamics, George Mason Univ., Fairfax, VA, USA
| | | | - Kerry M. Brown
- Krasnow Inst. for Advanced Study, George Mason Univ., Fairfax, VA, USA
| | | | | | - Juan R. Cebral
- Krasnow Inst. for Advanced Study, George Mason Univ., Fairfax, VA, USA
- Center for Computational Fluid Dynamics, George Mason Univ., Fairfax, VA, USA
| | - Giorgio A. Ascoli
- Krasnow Inst. for Advanced Study, George Mason Univ., Fairfax, VA, USA
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Mocco J, Huston J, Fargen KM, Torner J, Brown RD. An angiographic atlas of intracranial arterial diameters associated with cerebral aneurysms. J Neurointerv Surg 2013; 6:533-5. [PMID: 23946098 DOI: 10.1136/neurintsurg-2013-010838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The successful treatment of intracranial aneurysms is dependent on a full understanding of the anatomic relationship of a given aneurysm to its parent artery(s) and nearby branches. Furthermore, new endovascular technologies are often limited by size constraints. Currently, there is no complete atlas describing diameters for each major intracranial arterial segment. We sought to obtain these data by performing a systematic analysis of selected cerebral angiography images from the International Study of Unruptured Intracranial Aneurysms (ISUIA). METHODS Four hundred and forty-five patients with unruptured intracranial aneurysms from the ISUIA database were reviewed. Using previously described techniques, artery diameters were measured for all arteries involved in the aneurysm neck for each patient. RESULTS Measurements were obtained from 695 different aneurysm-associated arterial segments among 445 patient angiograms (mean 1.6 measurements per aneurysm). Artery diameters, mean, median, SEM and IQRs based upon the different arterial segments are presented. CONCLUSIONS This angiographic almanac of aneurysm-associated intracranial arterial diameters may be of benefit in establishing standard norms through which devices, protocols and research aims may be developed.
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Affiliation(s)
- J Mocco
- Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, USA
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kyle M Fargen
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - James Torner
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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