1
|
Wiśniewski K, Tyfa Z, Reorowicz P, Brandel MG, Adel T, Obidowski D, Jóźwik K, Levy ML. Numerical flow experiment for assessing predictors for cerebrovascular accidents in patients with PHACES syndrome. Sci Rep 2024; 14:5161. [PMID: 38431727 PMCID: PMC10908848 DOI: 10.1038/s41598-024-55345-6] [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: 04/02/2023] [Accepted: 02/22/2024] [Indexed: 03/05/2024] Open
Abstract
There is an increased risk of cerebrovascular accidents (CVA) in individuals with PHACES, yet the precise causes are not well understood. In this analysis, we aimed to examine the role of arteriopathy in PHACES syndrome as a potential contributor to CVA. We analyzed clinical and radiological data from 282 patients with suspected PHACES syndrome. We analyzed clinical features, including the presence of infantile hemangioma and radiological features based on magnetic resonance angiography or computed tomography angiography, in individuals with PHACES syndrome according to the Garzon criteria. To analyze intravascular blood flow, we conducted a simulation based on the Fluid-Structure Interaction (FSI) method, utilizing radiological data. The collected data underwent statistical analysis. Twenty patients with PHACES syndrome were included. CVAs were noted in 6 cases. Hypoplasia (p = 0.03), severe tortuosity (p < 0.01), absence of at least one main cerebral artery (p < 0.01), and presence of persistent arteries (p = 0.01) were associated with CVAs, with severe tortuosity being the strongest predictor. The in-silico analysis showed that the combination of hypoplasia and severe tortuosity resulted in a strongly thrombogenic environment. Severe tortuosity, combined with hypoplasia, is sufficient to create a hemodynamic environment conducive to thrombus formation and should be considered high-risk for cerebrovascular accidents (CVAs) in PHACES patients.
Collapse
Affiliation(s)
- Karol Wiśniewski
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, 92123, USA.
- Department of Neurosurgery and Neurooncology, Medical University of Lodz, Barlicki University Hospital, Kopcińskiego 22, 90-153, Lodz, Poland.
- Institute of Turbomachinery, Lodz University of Technology, 219/223 Wolczanska Str., 90-924, Lodz, Poland.
| | - Zbigniew Tyfa
- Institute of Turbomachinery, Lodz University of Technology, 219/223 Wolczanska Str., 90-924, Lodz, Poland
| | - Piotr Reorowicz
- Institute of Turbomachinery, Lodz University of Technology, 219/223 Wolczanska Str., 90-924, Lodz, Poland
| | - Michael G Brandel
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, 92123, USA
| | - Thomas Adel
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, 92123, USA
- Medical University of Vienna, Spitalgasse 23 Str., 1090, Wien, Austria
| | - Damian Obidowski
- Institute of Turbomachinery, Lodz University of Technology, 219/223 Wolczanska Str., 90-924, Lodz, Poland
| | - Krzysztof Jóźwik
- Institute of Turbomachinery, Lodz University of Technology, 219/223 Wolczanska Str., 90-924, Lodz, Poland
| | - Michael L Levy
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, 92123, USA
| |
Collapse
|
2
|
Kliś KM, Wójtowicz D, Kwinta BM, Stachura K, Popiela TJ, Frączek MJ, Łasocha B, Gąsowski J, Milczarek O, Krzyżewski RM. Association of Arterial Tortuosity with Hemodynamic Parameters-A Computational Fluid Dynamics Study. World Neurosurg 2023; 180:e69-e76. [PMID: 37544598 DOI: 10.1016/j.wneu.2023.07.152] [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: 07/23/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Tortuosity of intracranial arteries has been proven to be associated with the risk of intracranial aneurysm development. We decided to analyze which aspects of tortuosity are correlated with hemodynamics parameters promoting intracranial aneurysm development. METHODS We constructed 73 idealized models of tortuous artery (length: 25 mm, diameter: 2.5 mm) with single bifurcation. For each model, on the course of segment before bifurcation, we placed 1-3 angles with measures 15, 30, 45, 60, or 75 degrees and arc lengths 2, 5, 7, 10, or 15 mm. We performed computational fluid dynamics analysis. Blood was modeled as Newtonian fluid. We have set velocity wave of 2 cardiac cycles. After performing simulation we calculated following hemodynamic parameters at the bifurcation: time average wall shear stress (TAWSS), time average wall shear stress gradient (TAWSSG), oscillatory shear index (OSI), and relative residence time (RRT). RESULTS We found a significant positive correlation with number of angles and TAWSS (R = 0.329; P < 0.01), TAWSSG (R = 0.317; P < 0.01), and negative with RRT (R = -0.335; P < 0.0.01). Similar results were obtained in terms of arcs lengths. On the other hand, mean angle measure was negatively correlated to TAWSS (R = -0.333; P < 0.01), TAWSSG (R = -0.473 P < 0.01), OSI (R = -0.463; P < 0.01), and positively to RRT (R = 0.332; P < 0.01). On the basis of the obtained results, we developed new tortuosity descriptor, which considered angle measures normalized to its arc length and distance from bifurcation. For such descriptor we found strong negative correlation with TAWSS (R = -0.701; P < 0.01), TAWSSG (R = 0.778; P < 0.01), OSI (R = -0.776; P < 0.01), and positive with RRT (R = 0.747; P < 0.01). CONCLUSIONS Hemodynamic parameters promoting aneurysm development are correlated with larger number of smaller angles located on larger arcs.
Collapse
Affiliation(s)
- Kornelia M Kliś
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland.
| | - Dominika Wójtowicz
- Anaesthesiology and Intensive Care Clinical Department, University Hospital of Krakow, Kraków, Poland
| | - Borys M Kwinta
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Krzysztof Stachura
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Tadeusz J Popiela
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej J Frączek
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Bartłomiej Łasocha
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Gąsowski
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| | - Olga Milczarek
- Department of Children's Neurosurgery, Jagiellonian University Medical College, Faculty of Medicine, Institute of Pediatrics, Kraków, Poland
| | - Roger M Krzyżewski
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
3
|
Carrillo D, Edwards N, Arancibia‐Altamirano D, Otárola F, Villarroel C, Prieto CP, Villamizar‐Sarmiento MG, Sauma D, Valenzuela F, Lattus J, Oyarzun‐Ampuero F, Palma V. Efficacy of stem cell secretome loaded in hyaluronate sponge for topical treatment of psoriasis. Bioeng Transl Med 2023; 8:e10443. [PMID: 36925706 PMCID: PMC10013801 DOI: 10.1002/btm2.10443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/12/2022] [Accepted: 10/30/2022] [Indexed: 02/24/2023] Open
Abstract
Psoriasis vulgaris is an inflammatory disease characterized by distinctive skin lesions and dysregulated angiogenesis. Recent research uses stem cell secretion products (CM); a set of bioactive factors with therapeutic properties that regulate several cellular processes, including tissue repair and angiogenesis. The aim of this work was to evaluate the effect of CM of Wharton's gelatin MSC (hWJCM) in a treatment based on the bioactivation of a hyaluronic acid matrix (HA hWJCM) in a psoriasiform-like dermatitis (PD) mouse model. A preclinical study was conducted on PD mice. The effect of hWJCM, Clobetasol (Clob) gold standard, HA Ctrl, and HA hWJCM was tested topically evaluating severity of PD, mice weight as well as skin, liver, and spleen appearance. Treatment with either hWJCM, HA Ctrl or HA hWJCM, resulted in significant improvement of the PD phenotype. Moreover, treatment with HA hWJCM reduced the Psoriasis Area Severity Index (PASI), aberrant angiogenesis, and discomfort associated with the disease, leading to total recovery of body weight. We suggest that the topical application of HA hWJCM can be an effective noninvasive therapeutic solution for psoriasis, in addition to other skin diseases, laying the groundwork for future studies in human patients.
Collapse
Affiliation(s)
- Daniela Carrillo
- Laboratory of Stem Cells and Developmental Biology, Faculty of SciencesUniversidad de ChileSantiagoChile
- Facultad de Medicina y CienciaUniversidad San SebastianConcepciónChile
| | - Natalie Edwards
- Laboratory of Stem Cells and Developmental Biology, Faculty of SciencesUniversidad de ChileSantiagoChile
| | - David Arancibia‐Altamirano
- Laboratory of Stem Cells and Developmental Biology, Faculty of SciencesUniversidad de ChileSantiagoChile
| | - Fabiola Otárola
- Laboratory of Stem Cells and Developmental Biology, Faculty of SciencesUniversidad de ChileSantiagoChile
| | - Cynthia Villarroel
- Laboratory of Stem Cells and Developmental Biology, Faculty of SciencesUniversidad de ChileSantiagoChile
| | - Catalina P Prieto
- Laboratory of Stem Cells and Developmental Biology, Faculty of SciencesUniversidad de ChileSantiagoChile
| | - María Gabriela Villamizar‐Sarmiento
- Advanced Center of Chronic Diseases (ACCDiS), Universidad de ChileSantiagoChile
- Department of Sciences and Pharmaceutical Technology, Faculty of Chemical and Pharmaceutical SciencesUniversidad de ChileSantiagoChile
| | - Daniela Sauma
- Department of Biology, Faculty of SciencesUniversidad de ChileSantiagoChile
| | - Fernando Valenzuela
- Dermatology Department, Faculty of MedicineUniversidad de ChileSantiagoChile
| | - José Lattus
- Campus Oriente, Department of Obstetrics and Gynecology, Faculty of MedicineUniversity of ChileSantiago de ChileChile
| | - Felipe Oyarzun‐Ampuero
- Advanced Center of Chronic Diseases (ACCDiS), Universidad de ChileSantiagoChile
- Department of Sciences and Pharmaceutical Technology, Faculty of Chemical and Pharmaceutical SciencesUniversidad de ChileSantiagoChile
| | - Verónica Palma
- Laboratory of Stem Cells and Developmental Biology, Faculty of SciencesUniversidad de ChileSantiagoChile
| |
Collapse
|
4
|
Zhao J, Xiang X, Zhang H, Ye Y, He Z. A Study of the Association Between Carotid Artery Curvature and Intracranial Aneurysms. Neurologist 2023; 28:99-103. [PMID: 35697041 PMCID: PMC9977412 DOI: 10.1097/nrl.0000000000000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Carotid artery curvature is considered a sign of a weak vessel wall, and we hypothesize that a weak vascular wall under the effect of hemodynamics may cause intracranial aneurysms. MATERIALS AND METHODS The general data of 534 patients with aneurysms and 473 control patients were retrospectively analyzed in a case-control study. Carotid artery curvature was characterized as none, tortuosity, kinking, and coiling by computed tomography angiography images. Univariate analysis was performed to determine the degree of carotid artery tortuosity and to analyze the general data between the aneurysm group and the control group, and then, multivariate statistical logistic regression analysis was used to analyze the statistical significance of the univariate analysis. Finally, the correlation between aneurysm-related features and carotid artery curvature was analyzed. RESULTS Univariate analysis showed that kinking was significantly related to the occurrence of intracranial aneurysms ( P =0.009). The results of multivariate regression analysis showed that kinking was an independent risk factor for the occurrence of aneurysms (odds ratio: 1.942; 95% confidence interval: 1.387-2.720 for model 1; odds ratio: 1.995; 95% confidence interval: 1.419-2.805 for model 2). In the analysis of the correlation between the characteristics of intracranial aneurysms and the curvature of the internal carotid artery, there was no correlation between the curvature of the internal carotid artery and the size, location or number of aneurysms, or whether the intracranial aneurysm was ruptured. CONCLUSION Intracranial aneurysms are associated with carotid artery curvature. Kinking of the internal carotid artery may indicate a higher risk for aneurysm formation.
Collapse
Affiliation(s)
- Jun Zhao
- Department of Neurosurgery, Dazhou integrated TCM&Western Medicine Hospital
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiang Xiang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongxia Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ying Ye
- School of Health caring Industry, Sichuan University of Arts and Science, Dazhou
| | - Zhaohui He
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
5
|
Krzyżewski RM, Kliś KM, Kwinta BM, Łasocha B, Brzegowy P, Popiela TJ, Gąsowski J. Subarachnoid Hemorrhage from Ruptured Internal Carotid Artery Aneurysm: Association with Arterial Tortuosity. World Neurosurg 2022; 166:e84-e92. [PMID: 35811029 DOI: 10.1016/j.wneu.2022.06.101] [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: 04/05/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Many researchers have found a correlation between tortuous arteries and development of aneurysms in cerebral arteries. We decided to determine whether tortuosity of the internal carotid artery can be related to its aneurysm rupture. METHODS We retrospectively analyzed the internal carotid artery anatomy of 149 patients with internal carotid artery aneurysms. For each patient, we calculated relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD), and inflection count metrics (ICM). RESULTS A total of 33 patients (22.15%) had subarachnoid hemorrhage. These patients had significantly lower SOAM (0.31 ± 0.17 vs. 0.42 ± 0.21; P < 0.01), TI (0.27 ± 0.09 vs. 0.31 ± 0.11; P = 0.03) and ICM (0.25 ± 0.11 vs. 0.31 ± 0.17; P = 0.04). In multivariate logistic regression analysis, higher SOAM (odds ratio, 0.780; 95% confidence interval, 0.619-0.961; P = 0.025) remained independently associated with lower risk of internal carotid artery aneurysm rupture. In addition, we found significant positive correlation of aneurysm dome size with SOAM (R = 0.224; P = 0.013) and PAD (0.269; P < 0.01). Our study also showed that age (R = 0.252; P = 0.036), Glasgow Coma Scale score (R = -0.706; P < 0.01), and TI (R = -0.249; P = 0.042) were independently correlated with modified Rankin Scale score on discharge. CONCLUSIONS Lower tortuosity might be a protective factor against internal carotid artery aneurysm rupture and poor outcome after subarachnoid hemorrhage. Higher tortuosity is correlated with internal carotid artery aneurysm growth.
Collapse
Affiliation(s)
- Roger M Krzyżewski
- Departments of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland.
| | - Kornelia M Kliś
- Departments of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Borys M Kwinta
- Departments of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Bartłomiej Łasocha
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Brzegowy
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Tadeusz J Popiela
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Gąsowski
- Departments of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
6
|
Kim HJ, Song HN, Lee JE, Kim YC, Baek IY, Kim YS, Chung JW, Jee TK, Yeon JY, Bang OY, Kim GM, Kim KH, Kim JS, Hong SC, Seo WK, Jeon P. How Cerebral Vessel Tortuosity Affects Development and Recurrence of Aneurysm: Outer Curvature versus Bifurcation Type. J Stroke 2021; 23:213-222. [PMID: 34102756 PMCID: PMC8189854 DOI: 10.5853/jos.2020.04399] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose Previous studies have assessed the relationship between cerebral vessel tortuosity and intracranial aneurysm (IA) based on two-dimensional brain image analysis. We evaluated the relationship between cerebral vessel tortuosity and IA according to the hemodynamic location using three-dimensional (3D) analysis and studied the effect of tortuosity on the recurrence of treated IA.
Methods We collected clinical and imaging data from patients with IA and disease-free controls. IAs were categorized into outer curvature and bifurcation types. Computerized analysis of the images provided information on the length of the arterial segment and tortuosity of the cerebral arteries in 3D space.
Results Data from 95 patients with IA and 95 controls were analyzed. Regarding parent vessel tortuosity index (TI; P<0.01), average TI (P<0.01), basilar artery (BA; P=0.02), left posterior cerebral artery (P=0.03), both vertebral arteries (VAs; P<0.01), and right internal carotid artery (P<0.01), there was a significant difference only in the outer curvature type compared with the control group. The outer curvature type was analyzed, and the occurrence of an IA was associated with increased TI of the parent vessel, average, BA, right middle cerebral artery, and both VAs in the logistic regression analysis. However, in all aneurysm cases, recanalization of the treated aneurysm was inversely associated with increased TI of the parent vessels.
Conclusions TIs of intracranial arteries are associated with the occurrence of IA, especially in the outer curvature type. IAs with a high TI in the parent vessel showed good outcomes with endovascular treatment.
Collapse
Affiliation(s)
- Hyung Jun Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ha-Na Song
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Eun Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon-Chul Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In-Young Baek
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| | - Ye-Sel Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Keun Jee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Je Young Yeon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon-Ha Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Soo Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Chyul Hong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| | - Pyeong Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
7
|
Kalashnikova L, Danilova M, Gubanova M, Dobrynina L, Dreval M, Krotenkova M. Aneurysms and pathological tortuosity of the internal carotid and vertebral arteries in patients with dissection of these vessels: a results of long-term study. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:7-12. [DOI: 10.17116/jnevro20211211217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
8
|
Voss S, Schechtl J, Nöbauer C, Bleiziffer S, Lange R. Patient eligibility for application of a two-filter cerebral embolic protection device during transcatheter aortic valve implantation: does one size fit all? Interact Cardiovasc Thorac Surg 2020; 30:605-612. [PMID: 31904829 DOI: 10.1093/icvts/ivz306] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study sought to determine the percentage of patients potentially eligible for implantation of the Sentinel™ Cerebral Protection System (Sentinel-CPS) during transcatheter aortic valve implantation (TAVI) and to identify the reasons for treatment exclusion. METHODS We retrospectively performed an analysis of pre-TAVI multislice computed tomography (MSCT) aortograms and data review of all patients undergoing a TAVI procedure in 2017 (n = 317). MSCT evaluation included the assessment of aortic arch anatomy and the vascular dimensions of the brachiocephalic and left common carotid artery. Data analysis focused on comorbid conditions, precluding 6-Fr sheath radial access and filter deployment due to history of previous artery interventions. RESULTS MSCT and data analysis showed Sentinel-CPS compatibility in 61.5% of patients (n = 195). Sentinel-CPS would have been contraindicated in 38.5% (n = 122) due to one or more of the following: (i) measured diameters of the filter-landing zones <9 or >15 mm in the brachiocephalic artery and <6.5 or >10 mm in the left common carotid artery (n = 116; 88 with carotid dimensions too small); (ii) significant subclavian artery stenosis (n = 4) or an aberrant subclavian artery (n = 3) precluding Sentinel-CPS implantation and (iii) clinical characteristics including hypersensitivity to nickel-titanium (n = 1), radial artery occlusion (n = 1) or previous left common carotid artery interventions (n = 5). CONCLUSIONS MSCT and clinical data supported Sentinel-CPS compatibility in 61.5% of patients. The most common reason for treatment exclusion was inappropriate diameter within the target landing zone of the left carotid artery. Future device development should address this limitation.
Collapse
Affiliation(s)
- Stephanie Voss
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, German Heart Centre Munich, Insure (Institute of Translational Cardiac Surgery), Technische Universität München, Munich, Germany
| | - Johanna Schechtl
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, German Heart Centre Munich, Insure (Institute of Translational Cardiac Surgery), Technische Universität München, Munich, Germany
| | - Christian Nöbauer
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, German Heart Centre Munich, Insure (Institute of Translational Cardiac Surgery), Technische Universität München, Munich, Germany
| | - Sabine Bleiziffer
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Department of Cardiovascular Surgery, German Heart Centre Munich, Insure (Institute of Translational Cardiac Surgery), Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| |
Collapse
|
9
|
Kliś KM, Krzyżewski RM, Kwinta BM, Łasocha B, Brzegowy P, Stachura K, Popiela TJ, Borek R, Gąsowski J. Increased tortuosity of basilar artery might be associated with higher risk of aneurysm development. Eur Radiol 2020; 30:5625-5632. [PMID: 32405752 PMCID: PMC7476915 DOI: 10.1007/s00330-020-06917-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/23/2020] [Accepted: 04/23/2020] [Indexed: 01/30/2023]
Abstract
Objectives We analysed tortuosity of basilar artery (BA) to determine its relationship with the presence of aneurysm. Methods We retrospectively analysed 71 patients with BA aneurysms along with 71 age- and risk factors-matched control patients without BA aneurysm. From patients’ medical records, we obtained their history including previous and current diseases and medications. For each patient, we calculated relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD) and inflexion count metrics (ICM). We used t-test and Mann-Whitney U test for continuous variables and χ2 test for dichotomised variables. To find independent predictors of BA aneurysm, we employed logistic regression analysis. Results We found significant positive correlation between age and SOAM (R = 0.195, p = 0.02) and PAD (R = 0.199, p = 0.018). Our study also showed that patients with BA aneurysm had significantly higher SOAM (0.21 ± 0.16 vs. 0.11 ± 0.08; p < 0.01), PAD (0.30 ± 0.19 vs. 0.18 ± 0.11; p < 0.01), TI (0.23 ± 0.23 vs. 0.10 ± 0.16; p < 0.01) and ICM (0.20 ± 0.16 vs. 0.15 ± 0.11; p = 0.045). In multivariate logistic regression analysis, after adjustment for all possible confounders, SOAM (OR = 1.086; 95% CI 1.046–1.136; p < 0.01) and TI (OR = 1.004; 95%C: 1.002–1.006; p < 0.01) remained independently associated with higher risk of BA aneurysm. Conclusions Increased tortuosity of BA is associated with higher risk of its aneurysm development. Key Points • Basilar artery sum of angle metrics and product of angle distance are correlated with age. • Basilar artery tortuosity is independently associated with higher risk of its aneurysm development. • Basilar artery tortuosity is positively correlated with its diameter and bifurcation angle.
Collapse
Affiliation(s)
- Kornelia M Kliś
- Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Computer Science, Electronics and Telecommunications, AGH University of Science and Technology, Kraków, Poland.,TENSOR- Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland
| | - Roger M Krzyżewski
- TENSOR- Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland. .,Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Macieja Jakubowskiego 2 Street, 30-688, Kraków, Poland.
| | - Borys M Kwinta
- TENSOR- Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland.,Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Macieja Jakubowskiego 2 Street, 30-688, Kraków, Poland
| | - Bartłomiej Łasocha
- Department of Radiology, Jagiellonian University Medical College, University Hospital, Kraków, Poland
| | - Paweł Brzegowy
- Department of Radiology, Jagiellonian University Medical College, University Hospital, Kraków, Poland
| | - Krzysztof Stachura
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Macieja Jakubowskiego 2 Street, 30-688, Kraków, Poland
| | - Tadeusz J Popiela
- Department of Radiology, Jagiellonian University Medical College, University Hospital, Kraków, Poland
| | - Radosław Borek
- 1st Department of Internal Medicine with Cardiology Subdivision, Blessed Marta Wiecka District Hospital, Bochnia, Poland
| | - Jerzy Gąsowski
- TENSOR- Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland.,Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
10
|
Kliś KM, Krzyżewski RM, Kwinta BM, Stachura K, Moskała M, Tomaszewski KA. Computer-aided analysis of middle cerebral artery tortuosity: association with aneurysm development. J Neurosurg 2019; 130:1478-1484. [PMID: 29775150 DOI: 10.3171/2017.12.jns172114] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 12/04/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Blood vessel tortuosity may play an important role in the development of vessel abnormalities such as aneurysms. Currently, however, there are no studies analyzing the impact of brain blood vessel tortuosity on the risk of aneurysm formation. Therefore, the authors performed a computer-aided analysis of middle cerebral artery (MCA) tortuosity, especially among patients diagnosed with MCA aneurysms. METHODS Anatomy of the MCAs of 54 patients with unruptured MCA aneurysms was retrospectively analyzed, as was that of 54 sex-, age-, and vessel side-matched control patients without MCA aneurysms. From medical records, the authors obtained each patient's medical history including previous and current diseases and medications. For each patient, they calculated the following tortuosity descriptors: relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD), and inflection count metric (ICM). RESULTS Patients with an MCA aneurysm had significantly lower RLs (0.75 ± 0.09 vs 0.83 ± 0.08, p < 0.01), SOAMs (0.45 ± 0.10 vs 0.60 ± 0.17, p < 0.01), and PADs (0.34 ± 0.09 vs 0.50 ± 0.17, p < 0.01). They also had significantly higher TIs (0.87 ± 0.04 vs 0.81 ± 0.07, p < 0.01) and ICMs (3.07 ± 1.58 vs 2.26 ± 1.12, p < 0.01). Female patients had significantly higher RLs (0.76 ± 0.11 vs 0.80 ± 0.09, p = 0.03) than male patients. CONCLUSIONS Middle cerebral artery aneurysm formation is strongly associated with blood vessel tortuosity parameters, which can potentially be used to screen for patients at risk for MCA aneurysm formation.
Collapse
Affiliation(s)
- Kornelia M Kliś
- 1Jagiellonian University Medical College, Faculty of Medicine
- 2AGH University of Science and Technology, Faculty of Computer Science, Electronics and Telecommunications
| | - Roger M Krzyżewski
- 3Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College
| | - Borys M Kwinta
- 3Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College
| | - Krzysztof Stachura
- 3Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College
| | - Marek Moskała
- 3Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College
| | - Krzysztof A Tomaszewski
- 4Department of Anatomy, Jagiellonian University Medical College; and
- 5The Brain and Spine Laboratory, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
11
|
Krzyżewski RM, Kliś KM, Kwinta BM, Gackowska M, Gąsowski J. Increased tortuosity of ACA might be associated with increased risk of ACoA aneurysm development and less aneurysm dome size: a computer-aided analysis. Eur Radiol 2019; 29:6309-6318. [PMID: 30989348 PMCID: PMC6795631 DOI: 10.1007/s00330-019-06146-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/31/2019] [Accepted: 03/08/2019] [Indexed: 12/02/2022]
Abstract
Objectives We decided to perform computer-aided analysis of the anterior cerebral artery (ACA) to check for a potential correlation with anterior communicating artery (ACoA) aneurysm presence and growth. Methods We retrospectively analyzed the ACA anatomy of 121 patients with ACoA aneurysms along with 121 age, risk factors, and vessel side-matched control patients without an ACoA aneurysm. We obtained their medical history and digital subtraction angiography (DSA) data from their medical records. For each patient’s DSA, we extracted curve representing the course of their ACA and calculated its relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD), and inflection count metrics (ICM). Results Patients with ACoA aneurysm had significantly higher RL (0.64 ± 0.23 vs. 0.56 ± 0.22; p < 0.01), SOAM (0.27 ± 0.19 vs. 0.18 ± 0.15; p < 0.01), PAD (0.12 ± 0.13 vs. 0.09 ± 0.11; p = 0.02), and TI (0.57 ± 0.14 vs. 0.44 ± 0.15; p < 0.01). In multivariate logistic regression analysis, after adjustment for possible confounders, SOAM (OR, 1.34; 95% CI, 1.12–1.63; p < 0.01) and TI (OR, 1.84; 95% CI, 1.47–2.35; p < 0.01) remained independently associated with higher risk of ACoA aneurysm. Additionally, we found significant negative correlations between TI and aneurysm dome size (R = − 0.194; p = 0.047). Conclusions Increased tortuosity of ACA might increase the risk of ACoA aneurysm development and decrease the risk of aneurysm growth. Key Points • Anterior cerebral artery’s sum of angle metrics is associated with hypertension as well as with history of ischemic stroke and myocardial infarction. • Increased tortuosity of anterior cerebral artery might be associated with anterior communicating artery aneurysm development. • Tortuosity of anterior cerebral artery is negatively correlated with anterior communicating artery aneurysm dome size.
Collapse
Affiliation(s)
- Roger M Krzyżewski
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Botaniczna 3 Street, 31-503, Kraków, Poland. .,TENSOR- Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland.
| | - Kornelia M Kliś
- TENSOR- Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Computer Science, Electronics and Telecommunications, AGH University of Science and Technology, Kraków, Poland
| | - Borys M Kwinta
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Botaniczna 3 Street, 31-503, Kraków, Poland.,TENSOR- Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland
| | | | - Jerzy Gąsowski
- TENSOR- Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland.,Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
12
|
Tortuosity of the Internal Carotid Artery and Its Clinical Significance in the Development of Aneurysms. J Clin Med 2019; 8:jcm8020237. [PMID: 30759737 PMCID: PMC6406528 DOI: 10.3390/jcm8020237] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/16/2019] [Accepted: 02/01/2019] [Indexed: 02/03/2023] Open
Abstract
Tortuosity of blood vessels is a common angiographic finding that may indicate systemic disease and can be correlated with vascular pathologies. In this work, we determined whether patients with and without internal carotid artery (ICA) aneurysm presented with differences in its tortuosity descriptors. We retrospectively analysed data of 298 patients hospitalized between January 2014 and June 2018. For each patient's imaging data, we extracted a curve representing the ICA course and measured its Relative Length (RL), Sum of Angle Metrics (SOAM), Product of Angle Distance (PAD), Triangular Index (TI), and Inflection Count Metrics (ICM). We found that patients with an ICA aneurysm had significantly lower RL (0.46 ± 0.19 vs. 0.51 ± 0.17; p = 0.023) and significantly higher SOAM (0.39 ± 0.21 vs. 0.32 ± 0.21 p = 0.003), PAD (0.38 ± 0.19 vs. 0.32 ± 0.21; p = 0.011), TI (0.30 ± 0.11 vs. 0.27 ± 0.14; p = 0.034), and ICM (0.30 ± 0.16 vs. 0.22 ± 0.12; p < 0.001). We found that that patients who presented with a subarachnoid hemorrhage had significantly higher PAD (0.46 ± 0.22 vs. 0.35 ± 0.20; p = 0.024). In conclusion, higher tortuosity of ICA is associated with ICA aneurysm presence.
Collapse
|
13
|
de Vries EE, Pourier VEC, van Laarhoven CJHCM, Vonken EJ, van Herwaarden JA, de Borst GJ. Comparability of semiautomatic tortuosity measurements in the carotid artery. Neuroradiology 2018; 61:147-153. [PMID: 30338348 PMCID: PMC6348067 DOI: 10.1007/s00234-018-2112-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/04/2018] [Indexed: 12/19/2022]
Abstract
Purpose Increased arterial tortuosity has been suggested as a predisposing factor for carotid artery dissection, which is an important risk factor for development of extracranial carotid artery aneurysms (ECAA). Prior to comparison with non-ECAA controls, the optimal measurement technique should be defined. This study describes the difference between software packages in terms of reproducibility and absolute outcome of arterial tortuosity measurements in ECAA patients. Methods CT-angiography analysis was performed on 12 ECAA patients selected from our registry, using four software packages: 3mensio Vascular, TeraRecon, Vital Images, and Aycan OsiriX PRO. The tortuosity index (TI) was calculated from the skull base until the carotid bifurcation and aortic arch, and was defined as the centerline’s true length divided by the straight line distance. Intraclass correlation coefficients (ICC) with 95% confidence intervals were calculated to quantify inter- and intra-observer variability within one software package, and differences in measured TI between packages. Results Inter-observer agreement was nearly perfect for 3mensio, excellent for Vital Images and OsiriX, and substantial for TeraRecon, with ICC 0.99 (0.96–1.0), 0.90 (0.69–0.97), 0.84 (0.53–0.95), and 0.72 (0.28–0.91), respectively. Intra-observer agreement ranged from ICC 1.0 for 3mensio to 0.91 for TeraRecon. Agreements in TI ranged from ICC 0.99 (0.98–1.0) for 3mensio vs. OsiriX, to 0.95 (0.82–0.98) for 3mensio vs. TeraRecon. Median time needed to complete one round of measurements was highest for OsiriX (p = 0.013). Conclusions Carotid artery tortuosity measurements are reproducible and comparable between current commercially available software packages, with high intra-observer agreement. Although the reproducibility differed per software packages, all packages scored an acceptable inter-observer agreement.
Collapse
Affiliation(s)
- Evelien E de Vries
- Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Vanessa E C Pourier
- Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Constance J H C M van Laarhoven
- Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Evert J Vonken
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, the Netherlands.
| |
Collapse
|