1
|
Yi H, Yang Z, Bramlage L, Ludwig B. Pathophysiology of intracranial aneurysms in monozygotic twins: A rare case study from hemodynamic perspectives. Comput Biol Med 2023; 163:107198. [PMID: 37354818 DOI: 10.1016/j.compbiomed.2023.107198] [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: 03/13/2023] [Revised: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Abstract
Hemodynamic mechanisms of the formation and growth of intracranial aneurysms (IA) in monozygotic twins (MTs) are still under-reported. To partially fill such knowledge gap, this study employed an experimentally validated numerical model to compare hemodynamics in 3 anatomical and 5 ablation study neurovascular models from a rare pair of MTs in terms of 7 critical hemodynamic parameters. Numerical results showed significant differences in hemodynamics between the MTs, although they share the same genes, indicating that genetic mutation and environmental factors might affect neurovascular morphologies and cause hemodynamic changes. After virtual removals of IAs in the ablation study, the locations where the aneurysmal sac/bleb generated in bifurcated anterior cerebral arteries (ACAs) register a locally high instantaneous wall shear stress (IWSS) of 52.9 and 70.1 Pa at the systolic peak in twin A and twin B, respectively. Same scenario can be observed in the distribution of instantaneous wall shear stress gradient (IWSSG), with 571.1 Pa/mm for twin A and 301.3 Pa/mm for twin B due to aggressive blood impingements, leading to IA generation. The fenestrated complex approaching ACA bifurcations in twin A may assist IA growth and rupture, via. Causing abnormal IWSS of 116.3 Pa, IWSSG of 832.5 Pa/mm, and oscillatory shear index (OSI) of 0.49. The bleb in twin B has high risks of progression and possible rupture as the IA suffers relatively low IWSS and high OSI. Additionally, IA generation can change blood flow rates in each connected artery, then affecting blood supplies to associated tissues and organs.
Collapse
Affiliation(s)
- Hang Yi
- Department of Mechanical and Materials Engineering, Wright State University, Dayton, OH, 45435, USA
| | - Zifeng Yang
- Department of Mechanical and Materials Engineering, Wright State University, Dayton, OH, 45435, USA.
| | - Luke Bramlage
- Division of NeuroInterventional Surgery, Department of Neurology, Wright State University/Premier Health-Clinical Neuroscience Institute, 30E. Apple St., Dayton, OH, 45409, USA; Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| | - Bryan Ludwig
- Division of NeuroInterventional Surgery, Department of Neurology, Wright State University/Premier Health-Clinical Neuroscience Institute, 30E. Apple St., Dayton, OH, 45409, USA; Boonshoft School of Medicine, Wright State University, Dayton, OH, 45435, USA
| |
Collapse
|
2
|
Yi H, Yang Z, Bramlage LC, Ludwig BR. Morphology and Hemodynamics of Cerebral Arteries and Aneurysms in a Rare Pair of Monozygotic Twins. Diagnostics (Basel) 2023; 13:2004. [PMID: 37370899 DOI: 10.3390/diagnostics13122004] [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: 04/11/2023] [Revised: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
In this preliminary study, the underlying pathophysiology mechanisms of cerebral aneurysms (CAs) in monozygotic twins (MTs) were investigated via a rare pair of MTs (twin A and twin B) involving four reconstructed arterial models using preclinical information. First, dimensions and configurated outlines of three-perspective geometries were compared. Adopting an in-vitro validated numerical CA model, hemodynamic characteristics were investigated in the MTs, respectively. Despite expected genetic similarities, morphological comparisons show that configurations of cerebral arteries exhibit significant differences between the twins. The ICA size of twin A is larger than that in twin B (2.23~25.86%), varying with specific locations, attributing to variations during embryological developments and environmental influences. Numerical modeling indicates the MTs have some hemodynamic similarities such as pressure distributions (~13,400 Pa) and their oscillatory shear index (OSI) (0~0.49), but present significant differences in local regions. Specifically, the difference in blood flow rate in the MTs is from 16% to 221%, varying with specifically compared arteries. The maximum time-averaged wall shear stress (53.6 Pa vs. 37.8 Pa) and different local OSI distributions were also observed between the MTs. The findings revealed that morphological variations in MTs could be generated by embryological and environmental factors, further influencing hemodynamic characteristics on CA pathophysiology.
Collapse
Affiliation(s)
- Hang Yi
- Department of Mechanical and Materials Engineering, Wright State University, Dayton, OH 45435, USA
| | - Zifeng Yang
- Department of Mechanical and Materials Engineering, Wright State University, Dayton, OH 45435, USA
| | - Luke C Bramlage
- Division of NeuroInterventional Surgery, Department of Neurology, Wright State University/Premier Health-Clinical Neuroscience Institute, 30E Apple St., Dayton, OH 45409, USA
- Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| | - Bryan R Ludwig
- Division of NeuroInterventional Surgery, Department of Neurology, Wright State University/Premier Health-Clinical Neuroscience Institute, 30E Apple St., Dayton, OH 45409, USA
- Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA
| |
Collapse
|
3
|
The Genetics of Intracranial Aneurysms. CURRENT GENETIC MEDICINE REPORTS 2017. [DOI: 10.1007/s40142-017-0111-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Mackey J, Brown RD, Sauerbeck L, Hornung R, Moomaw CJ, Koller DL, Foroud T, Deka R, Woo D, Kleindorfer D, Flaherty ML, Meissner I, Anderson C, Rouleau G, Connolly ES, Huston J, Broderick JP. Affected twins in the familial intracranial aneurysm study. Cerebrovasc Dis 2015; 39:82-6. [PMID: 25571891 PMCID: PMC4348212 DOI: 10.1159/000369961] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Very few cases of intracranial aneurysms (IAs) in twins have been reported. Previous work has suggested that vulnerability to IA formation is heritable. Twin studies provide an opportunity to evaluate the impact of genetics on IA characteristics, including IA location. We therefore sought to examine IA location concordance, multiplicity, and rupture status within affected twin-pairs. METHODS The Familial Intracranial Aneurysm study was a multicenter study whose goal was to identify genetic and other risk factors for formation and rupture of IAs. The study required at least three affected family members or an affected sibling pair for inclusion. Subjects with fusiform aneurysms, an IA associated with an AVM, or a family history of conditions known to predispose to IA formation, such as polycystic kidney disease, Ehlers-Danlos syndrome, Marfan syndrome, fibromuscular dysplasia, or moyamoya syndrome were excluded. Twin-pairs were identified by birth date and were classified as monozygotic (MZ) or dizygotic (DZ) through DNA marker genotypes. In addition to zygosity, we evaluated twin-pairs by smoking status, major arterial territory of IAs, and rupture status. Location concordance was defined as the presence of an IA in the same arterial distribution (ICA, MCA, ACA, and vertebrobasilar), irrespective of laterality, in both members of a twin-pair. The Fisher exact test was used for comparisons between MZ and DZ twin-pairs. RESULTS A total of 16 affected twin-pairs were identified. Location concordance was observed in 8 of 11 MZ twin-pairs but in only 1 of 5 DZ twin-pairs (p = 0.08). Three MZ subjects had unknown IA locations and comprised the three instances of MZ discordance. Six of the 11 MZ twin-pairs and none of the 5 DZ twin-pairs had IAs in the ICA distribution (p = 0.03). Multiple IAs were observed in 11 of 22 MZ and 5 of 10 DZ twin-pairs. Thirteen (13) of the 32 subjects had an IA rupture, including 10 of 22 MZ twins. CONCLUSIONS We found that arterial location concordance was greater in MZ than DZ twins, which suggests a genetic influence upon aneurysm location. The 16 twin-pairs in the present study are nearly the total of affected twin-pairs that have been reported in the literature to date. Further studies are needed to determine the impact of genetics in the formation and rupture of IAs.
Collapse
Affiliation(s)
- Jason Mackey
- Department of Neurology, Indiana University, Indianapolis, IN
| | | | - Laura Sauerbeck
- Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Richard Hornung
- Department of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | - Daniel L. Koller
- Department of Medical & Molecular Genetics, Indiana University, Indianapolis, IN
| | - Tatiana Foroud
- Department of Medical & Molecular Genetics, Indiana University, Indianapolis, IN
| | - Ranjan Deka
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH
| | - Daniel Woo
- Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Dawn Kleindorfer
- Department of Neurology, University of Cincinnati, Cincinnati, OH
| | | | | | - Craig Anderson
- The George Institute for International Health, University of Sydney, Sydney, Australia
| | - Guy Rouleau
- Notre Dame Hospital, University of Montreal, Montreal, Canada
| | | | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, MN
| | | |
Collapse
|
6
|
Woo D. Location, interaction, and anticipation of aneurysm formation. ACTA NEUROCHIRURGICA. SUPPLEMENT 2012; 115:279-80. [PMID: 22890681 DOI: 10.1007/978-3-7091-1192-5_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
It is well established that family members of those individuals with intracranial aneurysm are at high risk of intracranial aneurysms. In the past several years, more information on the heritability of location, familial susceptibility to cigarette smoking, and whether "anticipation" of aneurysm formation has been published. We review these three topics in detail and summarize what we gathered from this information.
Collapse
Affiliation(s)
- Daniel Woo
- Department of Neurology, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0525, USA.
| |
Collapse
|
7
|
Mackey J, Brown RD, Moomaw CJ, Hornung R, Sauerbeck L, Woo D, Foroud T, Gandhi D, Kleindorfer D, Flaherty ML, Meissner I, Anderson C, Rouleau G, Connolly ES, Deka R, Koller DL, Abruzzo T, Huston J, Broderick JP. Familial intracranial aneurysms: is anatomic vulnerability heritable? Stroke 2012. [PMID: 23204049 DOI: 10.1161/strokeaha.112.667261] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have suggested that family members with intracranial aneurysms (IAs) often harbor IAs in similar anatomic locations. IA location is important because of its association with rupture. We tested the hypothesis that anatomic susceptibility to IA location exists using a family-based IA study. METHODS We identified all affected probands and first-degree relatives (FDRs) with a definite or probable phenotype in each family. We stratified each IA of the probands by major arterial territory and calculated each family's proband-FDR territory concordance and overall contribution to the concordance analysis. We then matched each family unit to an unrelated family unit selected randomly with replacement and performed 1001 simulations. The median concordance proportions, odds ratios (ORs), and P values from the 1001 logistic regression analyses were used to represent the final results of the analysis. RESULTS There were 323 family units available for analysis, including 323 probands and 448 FDRs, with a total of 1176 IAs. IA territorial concordance was higher in the internal carotid artery (55.4% versus 45.6%; OR, 1.54 [1.04-2.27]; P=0.032), middle cerebral artery (45.8% versus 30.5%; OR, 1.99 [1.22-3.22]; P=0.006), and vertebrobasilar system (26.6% versus 11.3%; OR, 2.90 [1.05-8.24], P=0.04) distributions in the true family compared with the comparison family. Concordance was also higher when any location was considered (53.0% versus 40.7%; OR, 1.82 [1.34-2.46]; P<0.001). CONCLUSIONS In a highly enriched sample with familial predisposition to IA development, we found that IA territorial concordance was higher when probands were compared with their own affected FDRs than with comparison FDRs, which suggests that anatomic vulnerability to IA formation exists. Future studies of IA genetics should consider stratifying cases by IA location.
Collapse
Affiliation(s)
- Jason Mackey
- IU Health Neuroscience Center, 355 W 16th St, Suite 3200, Indianapolis, IN 46202, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|