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Takenaka T, Nakamura H, Yamada S, Kidani T, Tateishi A, Toyota S, Fujinaka T, Taki T, Wakayama A, Kishima H. A novel predictor of ischemic complications in the treatment of ruptured middle cerebral artery aneurysms: Neck-branching angle. World Neurosurg X 2024; 23:100370. [PMID: 38584877 PMCID: PMC10998237 DOI: 10.1016/j.wnsx.2024.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/14/2024] [Accepted: 03/20/2024] [Indexed: 04/09/2024] Open
Abstract
Objective The risk factors of procedural cerebral ischemia (CI) in ruptured middle cerebral artery (MCA) aneurysms are unclear. This study proposed the neck-branching angle (NBA), a simple quantitative indicator of the aneurysm neck and branch vessels, and analyzed its usefulness as a predictor of procedural CI in ruptured MCA aneurysms. Methods We retrospectively analyzed 128 patients with ruptured saccular MCA aneurysms who underwent surgical or endovascular treatment between January 2014 and June 2021. We defined the NBA as the angle formed by the MCA aneurysm neck and M2 superior or inferior branch vessel line. The superior and inferior NBA were measured on admission via three-dimensional computed tomography angiography on admission. We divided the patients into clipping (106 patients) and coiling (22 patients) groups according to the treatment. Risk factors associated with procedural CI were analyzed in each group. Results Both groups showed that an enlarged superior NBA was a significant risk factor for procedural CI (clipping, P < 0.0005; coiling group, P = 0.007). The receiver operating characteristic curve showed the closed thresholds of the superior NBA with procedural CI in both groups (clipping group, 128.5°, sensitivity and specificity of 0.667 and 0.848, respectively; coiling group, 130.9°, sensitivity and specificity of 1 and 0.889, respectively). Conclusion The NBA can estimate the procedural risk of ruptured MCA aneurysms. In addition, an enlarged superior NBA is a risk factor for procedural CI in both clipping and coiling techniques.
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Affiliation(s)
- Tomofumi Takenaka
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
| | - Hajime Nakamura
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shuhei Yamada
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Tomoki Kidani
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Osaka, Japan
| | - Akihiro Tateishi
- Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
| | - Shingo Toyota
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Toshiyuki Fujinaka
- Department of Neurosurgery, National Hospital Organization, Osaka National Hospital, Osaka, Osaka, Japan
| | - Takuyu Taki
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Akatsuki Wakayama
- Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Hindenes LB, Ingebrigtsen T, Isaksen JG, Håberg AK, Johnsen LH, Herder M, Mathiesen EB, Vangberg TR. Anatomical variations in the circle of Willis are associated with increased odds of intracranial aneurysms: The Tromsø study. J Neurol Sci 2023; 452:120740. [PMID: 37517271 DOI: 10.1016/j.jns.2023.120740] [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: 02/20/2023] [Revised: 07/06/2023] [Accepted: 07/23/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE Studies on patients suggest an association between anatomical variations in the Circle of Willis (CoW) and intracranial aneurysms (IA), but it is unclear whether this association is present in the general population. In this cross-sectional population study, we investigated the associations between CoW anatomical variations and IA. METHODS We included 1667 participants from a population sample with 3 T MRI time-of-flight angiography (40-84 years, 46.5% men). Saccular IAs were defined as protrusions in the intracranial arteries ≥2 mm, while variants of the CoW were classified according to whether segments were missing or hypoplastic (< 1 mm). We used logistic regression, adjusting for age and IA risk factors, to assess whether participants with incomplete CoW variants had a greater prevalence of IA and whether participants with specific incomplete variants had a greater prevalence of IA. RESULTS Participants with an incomplete CoW had an increased prevalence of IA (OR, 2.3 [95% CI 1.05-5.04]). This was mainly driven by the variant missing all three communicating arteries (OR, 4.2 [95% CI 1.7-1 0.3]) and the variant missing the P1 segment of the posterior cerebral artery (OR, 3.6 [95% CI 1.2-10.1]). The combined prevalence of the two variants was 15.4% but accounted for 28% of the IAs. CONCLUSION The findings suggest that an incomplete CoW is associated with an increased risk of IA for adults in the general population.
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Affiliation(s)
- Lars B Hindenes
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; PET Imaging Center, University Hospital of North Norway, Tromsø, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
| | - Jørgen G Isaksen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Neurosurgery, Ophthalmology, and Otorhinolaryngology, University Hospital of North Norway, Tromsø, Norway
| | - Asta K Håberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Radiology and Nuclear Medicine, St. Olav University Hospital, Trondheim, Norway
| | - Liv-Hege Johnsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Marit Herder
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; Department of Neurology, University Hospital of North Norway, Tromsø, Norway
| | - Torgil R Vangberg
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway; PET Imaging Center, University Hospital of North Norway, Tromsø, Norway.
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Wan H, Lu G, Huang L, Ge L, Jiang Y, Zhang X. Comparison of Solitaire and Neuroform Stenting for Coiling of Intracranial Bifurcation Aneurysms. Interv Neuroradiol 2023; 29:165-171. [PMID: 35234080 PMCID: PMC10152827 DOI: 10.1177/15910199221081249] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/18/2022] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare the technical performance and outcomes of Solitaire and Neuroform stents for treatment of intracranial bifurcation aneurysms (IBAs). METHODS IBAs treated by stent-assisted coiling using a Solitaire or Neuroform stent between October 2010 and December 2019 were retrospectively evaluated. Patient demographics, aneurysm information, treatment technique, periprocedural and device-related complications, parent artery angle change, along with initial and follow-up angiographic results were analyzed. RESULTS One hundred twenty-one patients with 121 IBAs treated with Solitaire (n = 101) or Neuroform (n = 20) stent-assisted coiling were included. Aneurysm size, thrombotic and hemorrhagic complication rate, initial occlusion rate and in-stent stenosis between the two cohorts were not significantly different. Aneurysm location was significantly different between the two groups (p = 0.032). Jailing technique rate for coiling was significantly higher in the Solitaire than the Neuroform group (70.3% vs. 35.0%, p < 0.01). Follow-up DSA demonstrated a significantly lower recurrence rate for the Solitaire cohort (2.9% vs. 22.2%, p = 0.016). Parent artery angle changes, immediately post-operative and on follow-up were significantly greater in the Solitaire stent group (p < 0.05). CONCLUSIONS For intracranial bifurcation aneurysms, Solitaire stent-assisted coiling achieved a significantly lower recurrence rate and induced more favorable parent artery angular remodeling than Neuroform stenting.
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Affiliation(s)
- Hailin Wan
- Department of Radiology, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Shanghai
200040, China
| | - Gang Lu
- Department of Radiology, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Shanghai
200040, China
| | - Lei Huang
- Department of Radiology, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Shanghai
200040, China
| | - Liang Ge
- Department of Radiology, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Shanghai
200040, China
| | - Yeqing Jiang
- Department of Radiology, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Shanghai
200040, China
| | - Xiaolong Zhang
- Department of Radiology, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Shanghai
200040, China
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Tan J, Zhu H, Huang J, Ouyang HY, Pan X, Zhao Y, Li M. The Association of Morphological Differences of Middle Cerebral Artery Bifurcation and Aneurysm Formation: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 167:17-27. [PMID: 36028112 DOI: 10.1016/j.wneu.2022.08.075] [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: 06/30/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE We explored the relationships between morphological parameters of middle cerebral artery (MCA) bifurcations based on imaging and the development of middle cerebral aneurysms. Artery bifurcations can form disordered hemodynamics which can promote the development of aneurysms, whereas the hemodynamic environment at the bifurcation tip is highly reliant on the bifurcation's geometry. METHODS We searched 3 electronic databases for all relevant, publicly available publications as of March 18, 2022. Through the screening of abstracts and full texts, a meta-analysis was performed to compare the daughter-to-daughter angle, the inclination angle (γ), and the parent vessel diameter of MCA bifurcations between patients in MCA aneurysm and non-aneurysm controls. RESULTS Ten articles describing 1012 patients with MCA aneurysms and 1106 control individuals without aneurysms were included in the analysis. The aneurysm group showed a larger daughter-to-daughter branch angle at MCA bifurcations than the non-aneurysm group (weighted mean difference [WMD] = 42.00; 95% confidence interval [CI], 33.77 to 50.23; P < 0.00001). The daughter-to-daughter angle was also larger in the MCA aneurysm group with than without an aneurysm side branch (WMD = 37.03; 95% CI, 26.57 to 47.50; P < 0.00001), and in the MCA aneurysm group than in the non-aneurysm control group (WMD = 41.87; 95% CI, 29.19 to 54.54; P < 0.00001). The aneurysm group had a larger inclination angle than the control group (WMD = 28.73; 95% CI, 18.78 to 38.69; P < 0.00001). In patients with a MCA aneurysm, the parent vessel of the branch with the MCA aneurysm tended to be smaller in diameter than the contralateral branch without the aneurysm (WMD = -0.12; 95% CI, -0.24 to 0.00; P = 0.05). CONCLUSIONS A larger daughter-to-daughter angle and larger inclination angle at MCA bifurcations are closely related to MCA bifurcation aneurysms. The parent vessel diameter is negatively related to MCA bifurcation aneurysms.
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Affiliation(s)
- Jiacong Tan
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Huaxin Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jilan Huang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | | | - Xinyi Pan
- Huankui Academy, Nanchang University, Nanchang, Jiangxi, China
| | - Yeyu Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Meihua Li
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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Ćmiel-Smorzyk K, Kawlewska E, Wolański W, Hebda A, Ładziński P, Kaspera W. Morphometry of cerebral arterial bifurcations harbouring aneurysms: a case-control study. BMC Neurol 2022; 22:49. [PMID: 35144578 PMCID: PMC8830006 DOI: 10.1186/s12883-022-02559-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/07/2022] [Indexed: 12/15/2022] Open
Abstract
Background Conclusions from studies evaluating vessel dimensions and their deviations from values resulting from the principle of minimum work (PMW) on the formation of intracranial aneurysms (IAs) are still inconclusive. Our study aimed to perform a 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, the 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. The MCA and BA bifurcation angles and the radii of the parent MCA and BA vessels with aneurysms were significantly higher than those of 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 did not significantly differ 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 an IA. The ROC analysis indicated that the α angle was the best performer in discriminating between aneurysmal and nonaneurysmal bifurcations. Conclusions The dimensions of the arteries forming the circle of Willis do not follow the PMW. Deviation from the energetically optimum geometry for bifurcations beyond the circle of Willis (particularly, a larger 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 shear stress in the walls of arterial bifurcations.
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Affiliation(s)
- K Ćmiel-Smorzyk
- Department of Neurosurgery, Medical University of Silesia, Regional Hospital, 41-200, Sosnowiec, Poland
| | - E Kawlewska
- Department of Biomechatronics, Silesian University of Technology, Zabrze, Poland
| | - W Wolański
- Department of Biomechatronics, Silesian University of Technology, Zabrze, Poland
| | - A Hebda
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - P Ładziński
- Department of Neurosurgery, Medical University of Silesia, Regional Hospital, 41-200, Sosnowiec, Poland
| | - W Kaspera
- Department of Neurosurgery, Medical University of Silesia, Regional Hospital, 41-200, Sosnowiec, Poland.
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Zhang J, Can A, Lai PMR, Mukundan S, Castro VM, Dligach D, Finan S, Gainer VS, Shadick NA, Savova G, Murphy SN, Cai T, Weiss ST, Du R. Geometric Features Associated with Middle Cerebral Artery Bifurcation Aneurysm Formation: A Matched Case-Control Study. J Stroke Cerebrovasc Dis 2021; 31:106268. [PMID: 34974241 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/17/2021] [Accepted: 12/03/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The pathogenesis of intracranial aneurysms is multifactorial and includes genetic, environmental, and anatomic influences. We aimed to identify image-based morphological parameters that were associated with middle cerebral artery (MCA) bifurcation aneurysms. MATERIALS AND METHODS We evaluated three-dimensional morphological parameters obtained from CT angiography (CTA) or digital subtraction angiography (DSA) from 317 patients with unilateral MCA bifurcation aneurysms diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016. We chose the contralateral unaffected MCA bifurcation as the control group, in order to control for genetic and environmental risk factors. Diameters and angles of surrounding parent and daughter vessels of 634 MCAs were examined. RESULTS Univariable and multivariable statistical analyses were performed to determine statistical significance. Sensitivity analyses with smaller (≤ 3 mm) aneurysms only and with angles excluded, were also performed. In a multivariable conditional logistic regression model we showed that smaller diameter size ratio (OR 0.0004, 95% CI 0.0001-0.15), larger daughter-daughter angles (OR 1.08, 95% CI 1.06-1.11) and larger parent-daughter angle ratios (OR 4.24, 95% CI 1.77-10.16) were significantly associated with MCA aneurysm presence after correcting for other variables. In order to account for possible changes to the vasculature by the aneurysm, a subgroup analysis of small aneurysms (≤ 3 mm) was performed and showed that the results were similar. CONCLUSIONS Easily measurable morphological parameters of the surrounding vasculature of the MCA may provide objective metrics to assess MCA aneurysm formation risk in high-risk patients.
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Affiliation(s)
- Jian Zhang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Jiangsu, China; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Anil Can
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Pui Man Rosalind Lai
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Srinivasan Mukundan
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA; Reveal Pharmaceuticals, Cambridge, MA, USA.
| | - Victor M Castro
- Research Information Systems and Computing, Mass General Brigham, Boston, MA, USA
| | - Dmitriy Dligach
- Boston Children's Hospital Informatics Program, Boston, MA, USA; Department of Computer Science, Loyola University, Chicago, IL, USA
| | - Sean Finan
- Boston Children's Hospital Informatics Program, Boston, MA, USA
| | - Vivian S Gainer
- Research Information Systems and Computing, Mass General Brigham, Boston, MA, USA
| | - Nancy A Shadick
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Guergana Savova
- Boston Children's Hospital Informatics Program, Boston, MA, USA
| | - Shawn N Murphy
- Research Information Systems and Computing, Mass General Brigham, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Tianxi Cai
- Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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Zhang X, Hao W, Han S, Ren CF, Yang L, Han Y, Gao B. Middle cerebral arterial bifurcation aneurysms are associated with bifurcation angle and high tortuosity. J Neuroradiol 2021; 49:392-397. [PMID: 34896148 DOI: 10.1016/j.neurad.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the association of middle cerebral artery (MCA) bifurcation aneurysms with bifurcation morphology. MATERIALS AND METHODS 205 patients were enrolled, including 61 patients with MCA bifurcation aneurysms and 144 non-aneurysmal subjects. Aneurysmal cases were divided into types C (aneurysm neck on extension of the parent artery centerline) and D (deviating neck). The radius of the parent artery M1 (RP) and bilateral branches (RS and RL, respectively), smaller (φS) and larger (φL) lateral angles, bifurcation angle, and arterial tortuosity from parent vessel to bilateral branches (TS and TL, respectively) were analyzed. Logistic regression and receiver operator characteristic (ROC) curve analysis were performed to identify risk factors and predictive values for MCA aneurysm presence and types. RESULTS In aneurysmal MCA bifurcations, bifurcating angle, TS, TL and RL were significantly larger (P<0.01), while φS was significantly smaller (P<0.001) than those in controls. The bifurcation angle, TS and LogitP were better morphological parameters for predicting MCA aneurysm presence with the AUC of 0.795, 0.932 and 0.951, respectively. Significant (P<0.05) differences were observed in the bifurcation angle, φL, RP, RL and TL between types C and D aneurysmal bifurcations. TL was an independent factor in discriminating types C from D aneurysms with an AUC of 0.802. CONCLUSIONS Bifurcation angle and arterial tortuosity from the parent artery to the branch forming a smaller angle with the parent artery have a higher value in distinguishing MCA aneurysmal from non-aneurysmal ones, and the tortuosity from the parent artery to the contralateral branch is the best indicator for distinguishing types C from D aneurysmal bifurcations.
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Affiliation(s)
- Xuejing Zhang
- Department of Medical Research and Neurosurgery, Shijiazhuang People's Hospital, China
| | - Weili Hao
- Department of Medical Research and Neurosurgery, Shijiazhuang People's Hospital, China
| | | | - Chun-Feng Ren
- Zhengzhou University First Affiliated Hospital, China
| | - Lei Yang
- Department of Medical Research and Neurosurgery, Shijiazhuang People's Hospital, China
| | - Yongfeng Han
- Department of Medical Research and Neurosurgery, Shijiazhuang People's Hospital, China
| | - Bulang Gao
- Department of Medical Research and Neurosurgery, Shijiazhuang People's Hospital, China.
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Kancheva AK, Velthuis BK, Ruigrok YM. Imaging markers of intracranial aneurysm development: A systematic review. J Neuroradiol 2021; 49:219-224. [PMID: 34634299 DOI: 10.1016/j.neurad.2021.09.001] [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: 05/12/2021] [Revised: 08/14/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Imaging markers of intracranial aneurysm (IA) development are not well established. PURPOSE To provide an overview of imaging markers of IA development. METHODS A systematic search of PubMed and Embase up to December 1st 2020 using predefined criteria. Thirty-six studies met our inclusion criteria. We performed a quantitative summary of the included studies. RESULTS We found converging evidence for A1 segment asymmetry as an anatomical marker of anterior communicating artery (Acom) aneurysm development, and moderate evidence for several other markers. No hemodynamic markers yielded converging or moderate evidence. There was large heterogeneity across studies, especially in the definitions of imaging markers and study outcomes used. Due to the poor methodological quality of many studies and unavailability of effect sizes or crude data to calculate effect sizes, a formal meta-analysis was not possible. Many studies had poor methodological quality and varied inmarkerdefinitions and outcome measuresused, which prevented us from performing a formal meta-analysis. CONCLUSIONS We only identified A1 segment asymmetry as an imaging marker of Acom aneurysm development with converging evidence. A meta-analysis was not possible due to the heterogeneity of marker definitions and outcomes used, and poor methodological quality of many studies. Future studies should use robust study designs and uniformly defined imaging markers and outcome measures.
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Affiliation(s)
- Angelina K Kancheva
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Ynte M Ruigrok
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, the Netherlands
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Zhu D, Chen Y, Zheng K, Chen C, Li Q, Zhou J, Jia X, Xia N, Wang H, Lin B, Ni Y, Pang P, Yang Y. Classifying Ruptured Middle Cerebral Artery Aneurysms With a Machine Learning Based, Radiomics-Morphological Model: A Multicentral Study. Front Neurosci 2021; 15:721268. [PMID: 34456680 PMCID: PMC8385786 DOI: 10.3389/fnins.2021.721268] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023] Open
Abstract
Objective Radiomics and morphological features were associated with aneurysms rupture. However, the multicentral study of their predictive power for specific-located aneurysms rupture is rare. We aimed to determine robust radiomics features related to middle cerebral artery (MCA) aneurysms rupture and evaluate the additional value of combining morphological and radiomics features in the classification of ruptured MCA aneurysms. Methods A total of 632 patients with 668 MCA aneurysms (423 ruptured aneurysms) from five hospitals were included. Radiomics and morphological features of aneurysms were extracted on computed tomography angiography images. The model was developed using a training dataset (407 patients) and validated with the internal (152 patients) and external validation (73 patients) datasets. The support vector machine method was applied for model construction. Optimal radiomics, morphological, and clinical features were used to develop the radiomics model (R-model), morphological model (M-model), radiomics-morphological model (RM-model), clinical-morphological model (CM-model), and clinical-radiomics-morphological model (CRM-model), respectively. A comprehensive nomogram integrating clinical, morphological, and radiomics predictors was generated. Results We found seven radiomics features and four morphological predictors of MCA aneurysms rupture. The R-model obtained an area under the receiver operating curve (AUC) of 0.822 (95% CI, 0.776, 0.867), 0.817 (95% CI, 0.744, 0.890), and 0.691 (95% CI, 0.567, 0.816) in the training, temporal validation, and external validation datasets, respectively. The RM-model showed an AUC of 0.848 (95% CI, 0.810, 0.885), 0.865 (95% CI, 0.807, 0.924), and 0.721 (95% CI, 0.601, 0.841) in the three datasets. The CRM-model obtained an AUC of 0.856 (95% CI, 0.820, 0.892), 0.882 (95% CI, 0.828, 0.936), and 0.738 (95% CI, 0.618, 0.857) in the three datasets. The CRM-model and RM-model outperformed the CM-model and M-model in the internal datasets (p < 0.05), respectively. But these differences were not statistically significant in the external dataset. Decision curve analysis indicated that the CRM-model obtained the highest net benefit for most of the threshold probabilities. Conclusion Robust radiomics features were determined related to MCA aneurysm rupture. The RM-model exhibited good ability in classifying ruptured MCA aneurysms. Integrating radiomics features into conventional models might provide additional value in ruptured MCA aneurysms classification.
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Affiliation(s)
- Dongqin Zhu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kuikui Zheng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chao Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiong Li
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Radiology, Wenzhou Central Hospital, Wenzhou, China
| | - Jiafeng Zhou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiufen Jia
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nengzhi Xia
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao Wang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Boli Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yifei Ni
- The First School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Peipei Pang
- GE Healthcare China Co., Ltd., Shanghai, China
| | - Yunjun Yang
- Department of Nuclear Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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10
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Zhang J, Can A, Lai PMR, Mukundan S, Castro VM, Dligach D, Finan S, Gainer VS, Shadick NA, Savova G, Murphy SN, Cai T, Weiss ST, Du R. Morphological variables associated with ruptured basilar tip aneurysms. Sci Rep 2021; 11:2526. [PMID: 33510194 PMCID: PMC7844275 DOI: 10.1038/s41598-021-81364-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 01/06/2021] [Indexed: 01/13/2023] Open
Abstract
Morphological factors of intracranial aneurysms and the surrounding vasculature could affect aneurysm rupture risk in a location specific manner. Our goal was to identify image-based morphological parameters that correlated with ruptured basilar tip aneurysms. Three-dimensional morphological parameters obtained from CT-angiography (CTA) or digital subtraction angiography (DSA) from 200 patients with basilar tip aneurysms diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016 were evaluated. We examined aneurysm wall irregularity, the presence of daughter domes, hypoplastic, aplastic or fetal PCoAs, vertebral dominance, maximum height, perpendicular height, width, neck diameter, aspect and size ratio, height/width ratio, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine statistical significance. In multivariable analysis, presence of a daughter dome, aspect ratio, and larger flow angle were significantly associated with rupture status. We also introduced two new variables, diameter size ratio and parent-daughter angle ratio, which were both significantly inversely associated with ruptured basilar tip aneurysms. Notably, multivariable analyses also showed that larger diameter size ratio was associated with higher Hunt-Hess score while smaller flow angle was associated with higher Fisher grade. These easily measurable parameters, including a new parameter that is unlikely to be affected by the formation of the aneurysm, could aid in screening strategies in high-risk patients with basilar tip aneurysms. One should note, however, that the changes in parameters related to aneurysm morphology may be secondary to aneurysm rupture rather than causal.
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Affiliation(s)
- Jian Zhang
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Anil Can
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Pui Man Rosalind Lai
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | | | - Victor M Castro
- Research Information Systems and Computing, Massachusetts General Brigham, Boston, MA, USA
| | - Dmitriy Dligach
- Boston Children's Hospital Informatics Program, Boston, MA, USA
- Department of Computer Science, Loyola University, Chicago, IL, USA
| | - Sean Finan
- Boston Children's Hospital Informatics Program, Boston, MA, USA
| | - Vivian S Gainer
- Research Information Systems and Computing, Massachusetts General Brigham, Boston, MA, USA
| | - Nancy A Shadick
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Guergana Savova
- Boston Children's Hospital Informatics Program, Boston, MA, USA
| | - Shawn N Murphy
- Research Information Systems and Computing, Massachusetts General Brigham, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Tianxi Cai
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Scott T Weiss
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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11
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Zhang J, Can A, Lai PMR, Mukundan S, Castro VM, Dligach D, Finan S, Gainer V, Shadick N, Savova G, Murphy SN, Cai T, Weiss ST, Du R. Geometric variations associated with posterior communicating artery aneurysms. J Neurointerv Surg 2021; 13:1049-1052. [PMID: 33479035 DOI: 10.1136/neurintsurg-2020-017062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hemodynamic stress, conditioned by the morphology of the surrounding vasculature, plays an important role in aneurysm formation. Our goal was to identify image-based location-specific parameters that are associated with posterior communicating artery (PCoA) aneurysms. METHODS Three-dimensional morphological parameters obtained from CT angiography or digital subtraction angiography from 187 patients with unilateral PCoA aneurysms, diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016, were evaluated. In order to control for genetic and clinical risk factors, we chose the contralateral unaffected PCoA as a control group. We examined diameters and angles of the surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine statistical significance. Sensitivity analyses with small aneurysms (≤5 mm) only and an unmatched analysis of 432 PCoA aneurysms and 197 control patients without PCoA aneurysms were also performed. RESULTS In a multivariable conditional logistic regression model we showed that smaller diameter size ratio (OR 1.45×10-5, 95% CI 1.12×10-7 to 1.88×10-3) and larger daughter-daughter angle (OR 1.04, 95% CI 1.02 to 1.07) were significantly associated with PCoA aneurysm presence after correcting for other variables. In subgroup analyses of small aneurysms (≤5 mm) and in an unmatched analysis the significance and direction of these results were preserved. CONCLUSIONS Larger daughter-daughter angles and smaller diameter size ratio are significantly associated with the presence of PCoA aneurysms. These simple parameters can be utilized to guide the risk assessment for the formation of PCoA aneurysms in high risk patients.
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Affiliation(s)
- Jian Zhang
- Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Anil Can
- Neurosurgery, Amsterdam University Medical Centers, Amsterdam, Noord-Holland, The Netherlands
| | | | | | - Victor M Castro
- Research Information Science and Computing, Mass General Brigham Inc, Somerville, Massachusetts, USA
| | - Dmitriy Dligach
- Computer Science, Loyola University Chicago, Chicago, Illinois, USA
| | - Sean Finan
- Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Vivian Gainer
- Research Information Systems and Computing, Mass General Brigham Inc, Boston, Massachusetts, USA
| | - Nancy Shadick
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Guergana Savova
- Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Shawn N Murphy
- Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tianxi Cai
- Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rose Du
- Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
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12
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Marchi F, Bonasia S, Chiappini A, Reinert M, Robert T. Clinical and radiological outcomes in relation with the anatomical orientation of clipped middle cerebral artery bifurcation aneurysms. Clin Neurol Neurosurg 2021; 202:106491. [PMID: 33486156 DOI: 10.1016/j.clineuro.2021.106491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The middle cerebral artery (MCA) bifurcation represents the most frequent location for intracranial aneurysms. Often, the aneurysmal dome can hide the origin of perforating arteries from the M1 segment during the surgical clipping causing ischemic lesions and worse clinical outcome. The aim of this paper is to analyze the association between the orientation of the aneurysm sac and the clinical and radiological outcomes after surgical clipping. METHODS Data from 50 MCA bifurcation clipped aneurysms in 47 patients were collected retrospectively. Three different groups were identified according to the aneurysmal sac orientation: anterior-inferior, posterior and superior. A possible association between the aneurysmal sac projection and the outcome was searched through a univariable logistic regression analysis. RESULTS Statistical analysis showed significant correlation between the radiologic evidence of post-operative ischemia in the posterior group (p = 0.046, RR = 1.65) and an increased risk in the superior orientation group (p = 0.145, RR = 1.38). The anterior-inferior group was, instead, significantly associated with no evidence of radiologic ischemia (p = 0.0019, RR = 0.58). CONCLUSION The orientation of the aneurysmal dome and sac represents a fundamental feature to be considered during the surgical clipping of the MCA aneurysms. Indeed, its posterior and superior projection is associated with a higher incidence of radiologic ischemic lesions due to the origin of perforating arteries from M1 segment behind the aneurysmal sac. The anterior-inferior orientation, on the contrary, is associated with a lower risk.
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Affiliation(s)
- Francesco Marchi
- Neurosurgery Department, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland.
| | - Sara Bonasia
- Neurosurgery Department, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - Alessio Chiappini
- Neurosurgery Department, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland; Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland
| | - Michael Reinert
- Neurosurgery Department, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland; Faculty of Medicine, University of the Southern Switzerland, Lugano, Switzerland; Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Thomas Robert
- Neurosurgery Department, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland; Faculty of Medicine, University of the Southern Switzerland, Lugano, Switzerland
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13
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Zhang J, Can A, Lai PMR, Mukundan S, Castro VM, Dligach D, Finan S, Gainer VS, Shadick NA, Savova G, Murphy SN, Cai T, Weiss ST, Du R. Surrounding vascular geometry associated with basilar tip aneurysm formation. Sci Rep 2020; 10:17928. [PMID: 33087795 PMCID: PMC7578056 DOI: 10.1038/s41598-020-74266-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/17/2020] [Indexed: 01/18/2023] Open
Abstract
Hemodynamic stress is thought to play an important role in the formation of intracranial aneurysms, which is conditioned by the geometry of the surrounding vasculature. Our goal was to identify image-based morphological parameters that were associated with basilar artery tip aneurysms (BTA) in a location-specific manner. Three-dimensional morphological parameters obtained from CT-angiography (CTA) or digital subtraction angiography (DSA) from 207 patients with BTAs and a control group of 106 patients with aneurysms elsewhere to control for non-morphological factors, who were diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016, were evaluated. We examined the presence of hypoplastic, aplastic or fetal PCoAs, vertebral dominance, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine statistical significance. Sensitivity analyses with small (≤ 3 mm) aneurysms only and with angles excluded, were also performed. In multivariable analysis, daughter-daughter angle was directly, and parent artery diameter and diameter size ratio were inversely associated with BTAs. These results remained significant in the subgroup analysis of small aneurysms (width ≤ 3 mm) and when angles were excluded. These easily measurable and robust parameters that are unlikely to be affected by aneurysm formation could aid in risk stratification for the formation of BTAs in high-risk patients.
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Affiliation(s)
- Jian Zhang
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Anil Can
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Pui Man Rosalind Lai
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | | | - Victor M Castro
- Research Information Systems and Computing, Massachusetts General Brigham, Boston, MA, USA
| | - Dmitriy Dligach
- Boston Children's Hospital Informatics Program, Boston, MA, USA
- Department of Computer Science, Loyola University, Chicago, IL, USA
| | - Sean Finan
- Boston Children's Hospital Informatics Program, Boston, MA, USA
| | - Vivian S Gainer
- Research Information Systems and Computing, Massachusetts General Brigham, Boston, MA, USA
| | - Nancy A Shadick
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Guergana Savova
- Boston Children's Hospital Informatics Program, Boston, MA, USA
| | - Shawn N Murphy
- Research Information Systems and Computing, Massachusetts General Brigham, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Tianxi Cai
- Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Scott T Weiss
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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14
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Morphological parameters of middle cerebral arteries associated with aneurysm formation. Neuroradiology 2020; 63:179-188. [PMID: 32814989 PMCID: PMC7846548 DOI: 10.1007/s00234-020-02521-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/13/2020] [Indexed: 10/26/2022]
Abstract
PURPOSE The objective of this work was to investigate the correlation between morphological parameters of the MCA and the formation of aneurysms. METHODS MCA aneurysms were diagnosed in 122 cases using CT angiography (including 30 cases of M1 proximal aneurysms, 70 cases of M1 bifurcation aneurysms, and 22 cases of distal aneurysms). Images from these cases were retrospectively compared with images from 50 healthy controls. Morphological parameters including the angle of the MCA with the ICA (α) and the ACA (β) were evaluated in the three aneurysm groups and the control group; parent-daughter angles (γ1, γ2), bifurcation angles (γ3), bifurcation diameters, angle ratios, and branch diameter ratios were also compared between the bifurcation aneurysm group and the control group. The blood vessel parameters between the aneurysm groups and controls were analyzed statistically. RESULTS There was no statistically significant difference in α between the three groups of aneurysms and the control group (P = 0.381). In comparing β between the three groups of aneurysms and the control group, statistically significant differences were only observed between the MCA distal aneurysm group and the control group (P = 0.010). Compared with the control group, MCA bifurcation aneurysms were associated with larger γ3 and smaller γ1 and γ2 (P < 0.001). This resulted in significantly larger angle ratios in the MCA bifurcation aneurysm group (P < 0.001). For the diameter measurements, the bifurcation diameter of the MCA bifurcation aneurysms was significantly smaller (P = 0.001). CONCLUSION The formation of MCA aneurysms is related to morphological parameters.
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15
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Age and morphology of posterior communicating artery aneurysms. Sci Rep 2020; 10:11545. [PMID: 32665589 PMCID: PMC7360743 DOI: 10.1038/s41598-020-68276-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/25/2020] [Indexed: 12/16/2022] Open
Abstract
Risk of intracranial aneurysm rupture could be affected by geometric features of intracranial aneurysms and the surrounding vasculature in a location specific manner. Our goal is to investigate the morphological characteristics associated with ruptured posterior communicating artery (PCoA) aneurysms, as well as patient factors associated with the morphological parameters.
Three-dimensional morphological parameters in 409 patients with 432 PCoA aneurysms diagnosed at the Brigham and Women’s Hospital and Massachusetts General Hospital between 1990 and 2016 who had available CT angiography (CTA) or digital subtraction angiography (DSA) were evaluated. Morphological parameters examined included aneurysm wall irregularity, presence of a daughter dome, presence of hypoplastic or aplastic A1 arteries and hypoplastic or fetal PCoA, perpendicular height, width, neck diameter, aspect and size ratio, height/width ratio, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine the association of morphological parameters with rupture of PCoA aneurysms. Additional analyses were performed to determine the association of patient factors with the morphological parameters. Irregular, multilobed PCoA aneurysms with larger height/width ratios and larger flow angles were associated with ruptured PCoA aneurysms, whereas perpendicular height was inversely associated with rupture in a multivariable model. Older age was associated with lower aspect ratio, with a trend towards lower height/width ratio and smaller flow angle, features that are associated with a lower rupture risk. Morphological parameters are easy to assess and could help in risk stratification in patients with unruptured PCoA aneurysms. PCoA aneurysms diagnosed at older age have morphological features associated with lower risk.
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16
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Huang Z, Zeng M, Tao WG, Zeng FY, Chen CQ, Zhang LB, Chen FH. A Hemodynamic Mechanism Correlating with the Initiation of MCA Bifurcation Aneurysms. AJNR Am J Neuroradiol 2020; 41:1217-1224. [PMID: 32554419 DOI: 10.3174/ajnr.a6615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/22/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have reported that MCA bifurcation aneurysms usually emerge on inclined bifurcations; however, the reason is unclear. We designed this study to explore hemodynamic mechanisms that correlate with the initiation of MCA bifurcation aneurysms. MATERIALS AND METHODS Fifty-four patients with unilateral MCA bifurcation aneurysms and 54 control patients were enrolled in this study after propensity score matching, and their clinical and CTA data were collected. We extracted the morphologic features of aneurysmal MCA bifurcations to build a simplified MCA bifurcation model and performed a computational fluid dynamics analysis. RESULTS The presence of MCA aneurysms correlated with smaller parent-daughter angles of MCA bifurcations (P < .001). Aneurysmal MCA bifurcations usually presented with inclined shapes. The computational fluid dynamics analysis demonstrated that when arterial bifurcations became inclined, the high-pressure regions and low wall shear stress regions shifted from the apexes of the arterial bifurcations to the inclined daughter arteries, while the initial sites of MCA bifurcation aneurysms often overlapped with the shifted high-pressure regions and low wall shear stress regions. CONCLUSIONS Our results suggest that the initiation of MCA bifurcation aneurysms may correlate with shifts of high-pressure regions and low wall shear stress regions that occur on inclined MCA bifurcations.
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Affiliation(s)
- Z Huang
- From the Departments of Neurosurgery (Z.H., M.Z., F.H.C., W.G.T.)
| | - M Zeng
- From the Departments of Neurosurgery (Z.H., M.Z., F.H.C., W.G.T.)
| | - W G Tao
- From the Departments of Neurosurgery (Z.H., M.Z., F.H.C., W.G.T.)
| | - F Y Zeng
- Radiology (F.Y.Z., C.Q.C.), Xiangya Hospital, Central South University, Changsha, China
| | - C Q Chen
- Radiology (F.Y.Z., C.Q.C.), Xiangya Hospital, Central South University, Changsha, China
| | - L B Zhang
- Department of Neurosurgery (L.B.Z.), School of Medicine, Yale University, New Haven, Connecticut
| | - F H Chen
- From the Departments of Neurosurgery (Z.H., M.Z., F.H.C., W.G.T.)
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17
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Zhang J, Can A, Mukundan S, Steigner M, Castro VM, Dligach D, Finan S, Yu S, Gainer V, Shadick NA, Savova G, Murphy S, Cai T, Wang Z, Weiss ST, Du R. Morphological Variables Associated With Ruptured Middle Cerebral Artery Aneurysms. Neurosurgery 2020; 85:75-83. [PMID: 29850834 DOI: 10.1093/neuros/nyy213] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/27/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Geometric factors of intracranial aneurysms and surrounding vasculature could affect the risk of aneurysm rupture. However, large-scale assessments of morphological parameters correlated with intracranial aneurysm rupture in a location-specific manner are scarce. OBJECTIVE To investigate the morphological characteristics associated with ruptured middle cerebral artery (MCA) aneurysms. METHODS Five hundred sixty-one patients with 638 MCA aneurysms diagnosed between 1990 and 2016 who had available computed tomography angiography (CTA) were included in this study. CTAs were evaluated using the Vitrea Advanced Visualization software for 3-dimensional (3D) reconstruction. Morphological parameters examined in each model included aneurysm projection, wall irregularity, presence of a daughter dome, presence of hypoplastic or aplastic A1 arteries and hypoplastic or fetal posterior communicating arteries (PCoA), aneurysm height and width, neck diameter, bottleneck factor, aspect and size ratio, height/width ratio, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine the association of morphological characteristics with rupture of MCA aneurysms. Logistic regression was used to build a predictive MCA score. RESULTS Greater bottleneck and size ratio, and irregular, multilobed, temporally projecting MCA aneurysms are associated with higher rupture risk, whereas higher M1/M2 ratio, larger width, and the presence of an ipsilateral or bilateral hypoplastic PCoA were inversely associated with rupture. The MCA score had good predictive capacity with area under the receiver operating curve = 0.88. CONCLUSION These practical morphological parameters specific to MCA aneurysms are easy to assess when examining 3D reconstructions of unruptured aneurysms and could aid in risk evaluation in these patients.
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Affiliation(s)
- Jian Zhang
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Jiangsu Province, China
| | - Anil Can
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Srinivasan Mukundan
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael Steigner
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Victor M Castro
- Research Information Systems and Computing, Partners Healthcare, Boston, Massachusetts
| | - Dmitriy Dligach
- Department of Computer Science, Loyola University, Chicago, Illinois
| | - Sean Finan
- Boston Children's Hospital Informatics Program, Boston, Massachusetts
| | - Sheng Yu
- Center for Statistical Science, Tsinghua University, Beijing, China
| | - Vivian Gainer
- Research Information Systems and Computing, Partners Healthcare, Boston, Massachusetts
| | - Nancy A Shadick
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts
| | - Guergana Savova
- Boston Children's Hospital Informatics Program, Boston, Massachusetts
| | - Shawn Murphy
- Research Information Systems and Computing, Partners Healthcare, Boston, Massachusetts.,Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Tianxi Cai
- Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Jiangsu Province, China
| | - Scott T Weiss
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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18
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Duan Y, Lagman C, Ems R, Bambakidis NC. Relationship between middle cerebral parent artery asymmetry and middle cerebral artery aneurysm rupture risk factors. J Neurosurg 2020; 132:1174-1181. [PMID: 30925467 DOI: 10.3171/2018.12.jns182951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 12/13/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The exact pathophysiological mechanisms underlying cerebral aneurysm formation remain unclear. Asymmetrical local vascular geometry may play a role in aneurysm formation and progression. The object of this study was to investigate the association between the geometric asymmetry of the middle cerebral artery (MCA) and the presence of MCA aneurysms and associated high-risk features. METHODS Using a retrospective case-control study design, the authors examined MCA anatomy in all patients who had been diagnosed with an MCA aneurysm in the period from 2008 to 2017 at the University Hospitals Cleveland Medical Center. Geometric features of the MCA ipsilateral to MCA aneurysms were compared with those of the unaffected contralateral side (secondary control group). Then, MCA geometry was compared between patients with MCA aneurysms and patients who had undergone CTA for suspected vascular pathology but were ultimately found to have normal intracranial vasculature (primary control group). Parent vessel and aneurysm morphological parameters were measured, calculated, and compared between case and control groups. Associations between geometric parameters and high-risk aneurysm features were identified. RESULTS The authors included 247 patients (158 cases and 89 controls) in the study. The aneurysm study group consisted of significantly more women and smokers than the primary control group. Patients with MCA bifurcation aneurysms had lower parent artery inflow angles (p = 0.01), lower parent artery tortuosity (p < 0.01), longer parent artery total length (p = 0.03), and a significantly greater length difference between ipsilateral and contralateral prebifurcation MCAs (p < 0.01) than those in primary controls. Type 2 MCA aneurysms (n = 89) were more likely to be associated with dome irregularity or a daughter sac and were more likely to have a higher cumulative total of high-risk features than type 1 MCA aneurysms (n = 69). CONCLUSIONS Data in this study demonstrated that a greater degree of parent artery asymmetry for MCA aneurysms is associated with high-risk features. The authors also found that the presence of a long and less tortuous parent artery upstream of an MCA aneurysm is a common phenotype that is associated with a higher risk profile. The aneurysm parameters are easily measurable and are novel radiographic biomarkers for aneurysm risk assessment.
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Affiliation(s)
- Yifei Duan
- 1University Hospitals Cleveland Medical Center; and
| | | | - Raleigh Ems
- 2School of Medicine, Case Western Reserve University, Cleveland, Ohio
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19
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Wang HF, Wang DM. Letter to the Editor. Relationship between MCA length and MCA aneurysm rupture. J Neurosurg 2020; 132:1306-1308. [PMID: 31628283 DOI: 10.3171/2019.7.jns191664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Kaspera W, Ćmiel-Smorzyk K, Wolański W, Kawlewska E, Hebda A, Gzik M, Ładziński P. Morphological and Hemodynamic Risk Factors for Middle Cerebral Artery Aneurysm: a Case-Control Study of 190 Patients. Sci Rep 2020; 10:2016. [PMID: 32029748 PMCID: PMC7005042 DOI: 10.1038/s41598-019-56061-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 10/30/2019] [Indexed: 12/31/2022] Open
Abstract
This study analyzed morphometric and hemodynamic parameters of aneurysmal and non-aneurysmal middle cerebral artery (MCA) bifurcations and their relationship with optimal values derived from the principle of minimum work (PMW). The study included 96 patients with MCA aneurysm and 94 controls. Aneurysm patients presented with significantly higher values of the radius and cross-sectional area of the MCA trunk, angle between the post-bifurcation branches (α angle) and volume flow rate (VFR) and had significantly lower values of junction exponent and pulsatility index than the controls. The Φ1 and Φ2 angles (angles between the MCA trunk axis and the larger and smaller branch, respectively) and α angle in all groups were significantly larger than the optimal PMW-derived angles. The most important independent predictors of MCA aneurysm were junction exponent (odds ratio, OR = 0.42), α angle (OR = 1.07) and VFR (OR = 2.36). Development of cerebral aneurysms might be an independent effect of abnormalities in hemodynamic and morphometric factors. The risk of aneurysm increased proportionally to the deviation of morphometric parameters of the bifurcation from their optimal PMW-derived values. The role of bifurcation angle in aneurysm development needs to be explained in future research as the values of this parameter in both aneurysm patients and non-aneurysmal controls in were scattered considerably around the PMW-derived optimum.
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Affiliation(s)
- Wojciech Kaspera
- Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland.
| | - Karolina Ćmiel-Smorzyk
- Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland
| | - Wojciech Wolański
- Department of Biomechatronics, Silesian University of Technology, Zabrze, Poland
| | - Edyta Kawlewska
- Department of Biomechatronics, Silesian University of Technology, Zabrze, Poland
| | - Anna Hebda
- Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Marek Gzik
- Department of Biomechatronics, Silesian University of Technology, Zabrze, Poland
| | - Piotr Ładziński
- Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland
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Ikedo T, Kataoka H, Minami M, Hayashi K, Miyata T, Nagata M, Fujikawa R, Yokode M, Imai H, Matsuda T, Miyamoto S. Sequential Inward Bending of Arterial Bifurcations is Associated with Intracranial Aneurysm Formation. World Neurosurg 2019; 129:e361-e366. [PMID: 31176059 DOI: 10.1016/j.wneu.2019.05.153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the association between vascular morphology and the development of intracranial aneurysms (IAs), the morphological changes of intracranial arteries after IA induction were examined using a rodent model. METHODS The vascular morphology of the circle of Willis in rats was visualized at 1 week and at 3 months after IA induction using 7-T magnetic resonance imaging. The following 2 angle parameters were defined: the angle between the parent artery and the daughter arteries (PD angle), and the widening of the daughter arteries (DD angle). The correlations of the angle parameters with IA size and with the number of macrophages infiltrated in the IA wall by immunohistochemistry were examined. RESULTS Magnetic resonance imaging showed bending of the arteries over time around the predilection site for IAs. The PD angle increased significantly 1 week after IA induction (P < 0.05) and correlated with IA size (P < 0.01). The DD angle did not increase after 1 week, but increased 3 months after IA induction (P < 0.01). The PD angle 1 week after surgery also correlated with the number of infiltrated macrophages in aneurysmal walls (P = 0.01). CONCLUSIONS Sequential inward bending of arterial bifurcations occurred after IA induction in the rat model. The degree of arterial bending correlated with IA development and inflammation in the IA wall, suggesting that the vascular morphology may be strongly associated with IA development through a proinflammatory mechanism.
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Affiliation(s)
- Taichi Ikedo
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Manabu Minami
- Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kosuke Hayashi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Miyata
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Nagata
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Risako Fujikawa
- Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Yokode
- Department of Clinical Innovative Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hirohiko Imai
- Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto, Japan
| | - Tetsuya Matsuda
- Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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22
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Iosif C, Biondi A. Braided stents and their impact in intracranial aneurysm treatment for distal locations: from flow diverters to low profile stents. Expert Rev Med Devices 2019; 16:237-251. [DOI: 10.1080/17434440.2019.1575725] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Christina Iosif
- Department of Neuroradiology and Endovascular Treatment, Jean-Minjoz University Hospital, Besancon, France
- Department of Interventional Neuroradiology, Erasmus University Hospital, Brussels, Belgium
- Associate Professor in Radiology, European University of Cyprus, Nicosia, Cyprus
| | - Alessandra Biondi
- Department of Neuroradiology and Endovascular Treatment, Jean-Minjoz University Hospital, Besancon, France
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23
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Song J, Zhu F, Qian Y, Ou C, Cai J, Zou X, Wu Z, Zhu W, Chen L, Mao Y. Morphological and Hemodynamic Differences Between Aneurysmal Middle Cerebral Artery Bifurcation and Contralateral Nonaneurysmal Anatomy. Neurosurgery 2018; 81:779-786. [PMID: 28379506 DOI: 10.1093/neuros/nyx093] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/10/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The morphological and hemodynamic features differ between middle cerebral artery (MCA) bifurcations with and without aneurysms. OBJECTIVE To investigate the morphological and hemodynamic differences between aneurysmal MCA bifurcation and contralateral nonaneurysmal anatomy. METHODS Computed tomography angiography of 36 patients with unilateral small saccular MCA bifurcation aneurysms was evaluated. The parent-daughter angles (φ1 for larger branch and φ2 for smaller branch), bifurcation angle (φ = φ1 + φ2), inclination angle (γ angle), and their relationships with the MCA bifurcation locations were analyzed. Computational fluid dynamics simulation was performed in 6 cases to explore the hemodynamics influenced by the bifurcation morphology. RESULTS The φ angle was significantly higher in aneurysmal than contralateral nonaneurysmal bifurcations (160.8° ± 31.0° vs 99.0° ± 19.2°, respectively; P = .000); the φ1, φ2, and γ angles were also higher. However, by regression analysis combined with MCA bifurcation locations, only the φ angle might be associated with the aneurysm presence (odds ratio = 1.120, 95% confidence interval = 1.059-1.185) and a φ angle cut-off of 124.8° was established. Computational fluid dynamics simulation demonstrated that flow resistance of the wider aneurysmal MCA bifurcation was significantly higher than that on the contralateral side. CONCLUSION A larger φ angle was more prevalent in aneurysmal than nonaneurysmal MCA bifurcations, and the higher flow resistance caused by the larger φ angle might be a potential hemodynamic factor associated with MCA aneurysm presence.
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Affiliation(s)
- Jianping Song
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Fengping Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.,Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Yi Qian
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Chubin Ou
- Department of Mechanical and Aerospace Engineering, Hong Kong University of Science and Technology, Hong Kong, China
| | - Jiajun Cai
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiang Zou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zehan Wu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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Bourcier R, Lenoble C, Guyomarch-Delasalle B, Daumas-Duport B, Papagiannaki C, Redon R, Desal H. Is there an inherited anatomical conformation favoring aneurysmal formation of the anterior communicating artery? J Neurosurg 2016; 126:1598-1605. [PMID: 27315030 DOI: 10.3171/2016.4.jns153032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The pathophysiological mechanisms responsible for the formation of intracranial aneurysms (IAs) remain only partially elucidated. However, current evidence suggests a genetic component. The purpose of this study was to investigate the specific anatomical variations in the arterial complex that are associated with the presence of anterior communicating artery (ACoA) aneurysms in the familial forms of IAs. METHODS This multicenter study investigated bifurcation IAs in patients who had a sporadic ACoA IA without a family history of IA (SACAA group), in patients who had an ACoA IA with a family history of IA (FACAA group), and in their healthy first-degree relatives (HFDRs). Through the use of MR angiography (MRA) reconstructions, the symmetry of the A1 segments and the angle between the A1 and A2 segments were analyzed on 3D models for each group. These measurements were then compared among the 3 groups. RESULTS Twenty-four patients with SACAA, 24 patients with FACAA, and 20 HFDRs were included in the study. Asymmetrical configuration of the A1 segments was more frequent in the FACAA group than in the HFDR group (p = 0.002). The aneurysm-side A1-A2 angle was lower in the FACAA group (p = 0.003) and SACAA group (p = 0.007) than in the HFDR group. On the contralateral side, there was no difference in A1-A2 angles between groups. CONCLUSIONS The anatomical shape of the ACoA complex seems to be similarly associated with the presence of ACoA IAs in both the FACAA and SACAA groups. This highlights the role played by hemodynamic constraints in aneurysm formation and questions the hypothesis of the hereditary character of these anatomical shapes.
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Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec.,CNRS, UMR 6291, Université de Nantes, Nantes; and
| | - Cédric Lenoble
- Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec
| | | | - Benjamin Daumas-Duport
- Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec
| | | | - Richard Redon
- INSERM, UMR1087, l'institut du thorax, CHU de Nantes.,CNRS, UMR 6291, Université de Nantes, Nantes; and
| | - Hubert Desal
- Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec.,CNRS, UMR 6291, Université de Nantes, Nantes; and
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