Is the middle cerebral artery bifurcation aneurysm affected by morphological parameters of bifurcation?
, 1, 2, 1, 1
Abstract
Background: Aneurysm formation is a multifactorial process involving genetic, anatomical and environmental risk factors. A research focusing on the relationship between the presence of aneurysm and the morphology of the arteries will help in the pathogenesis and prediction of intracranial aneurysms. In this study, the relationship between the presence of aneurysm and various morphological parameters of aneurysm-related arteries was evaluated in patients with saccular middle cerebral artery (MCA) bifurcation aneurysm.
Materials and methods: The archival images of 74 patients (62.2% women) were evaluated retrospectively. In this study, the angle between the ipsilateral MCA M1 segment and the dominant truncus (Φ1), the angle between the M1 segment and the recessive truncus (Φ2), and the bifurcation angle (Φ1 + Φ2) were compared. Bilateral internal carotid artery (ICA), MCA M1 segment, dominant and recessive truncus diameters and these diameters ratios were compared with the aneurysmal side and the contralateral side without aneurysm.
Results: When the dominant truncus, recessive truncus angles and bifurcation angle were compared, a significant difference was found on the aneurysmal side (p < 0.0001). In the receiver operating characteristic analysis, when the bifurcation angle of 147.5° was accepted as the limit value, 78.4% sensitivity, 79.7% specificity, 79.5% positive predictive value and 78.7% negative predictive value were determined (area under the curve: 0.85).
Conclusions: Our study of the morphological features of arteries associated with MCA bifurcation aneurysms showed that the presence of MCA aneurysms was significantly associated with large bifurcation angles.
Keywords: intracranial aneurysmbifurcation morphologyhaemodynamic changes
References
- Baharoglu MI, Lauric A, Safain MG, et al. Widening and high inclination of the middle cerebral artery bifurcation are associated with presence of aneurysms. Stroke. 2014; 45(9): 2649–2655.
- Bor AS, Velthuis BK, Majoie CB, et al. Configuration of intracranial arteries and development of aneurysms: a follow-up study. Neurology. 2008; 70(9): 700–705.
- Can A, Ho AL, Dammers R, et al. Morphological parameters associated with middle cerebral artery aneurysms. Neurosurgery. 2015; 76(6): 721–6; discussion 726.
- Finlay HM, Whittaker P, Canham PB. Collagen organization in the branching region of human brain arteries. Stroke. 1998; 29(8): 1595–1601.
- Gao B, Baharoglu MI, Cohen AD, et al. Y-stent coiling of basilar bifurcation aneurysms induces a dynamic angular vascular remodeling with alteration of the apical wall shear stress pattern. Neurosurgery. 2013; 72(4): 617–29; discussion 628.
- Greenberg M. Handbook of Neurosurgery. 6th ed. New York 2006: 289–365.
- Ingebrigtsen T, Morgan MK, Faulder K, et al. Bifurcation geometry and the presence of cerebral artery aneurysms. J Neurosurg. 2004; 101(1): 108–113.
- Kondo S, Hashimoto N, Kikuchi H, et al. Apoptosis of medial smooth muscle cells in the development of saccular cerebral aneurysms in rats. Stroke. 1998; 29(1): 181–8; discussion 189.
- Longstreth WT, Nelson LM, Koepsell TD, et al. Cigarette smoking, alcohol use, and subarachnoid hemorrhage. Stroke. 1992; 23(9): 1242–1249.
- Meng H, Wang Z, Hoi Y, et al. Complex hemodynamics at the apex of an arterial bifurcation induces vascular remodeling resembling cerebral aneurysm initiation. Stroke. 2007; 38(6): 1924–1931.
- Murray CD. The physiological principle of minimum work applied to the angle of branching of arteries. J Gen Physiol. 1926; 9(6): 835–841.
- Murray CD. The physiological principle of minimum work: I. The vascular system and the cost of blood volume. Proc Natl Acad Sci U S A. 1926; 12(3): 207–214.
- Przelomski MM, Fisher M, Davidson RI, et al. Unruptured intracranial aneurysm and transient focal cerebral ischemia: a follow-up study. Neurology. 1986; 36(4): 584–587.
- Raps EC, Rogers JD, Galetta SL, et al. The clinical spectrum of unruptured intracranial aneurysms. Arch Neurol. 1993; 50(3): 265–268.
- Roach MR, Scott S, Ferguson GG. The hemodynamic importance of the geometry of bifurcations in the circle of Willis (glass model studies). Stroke. 1972; 3(3): 255–267.
- Sadatomo T, Yuki K, Migita K, et al. Differences between middle cerebral artery bifurcations with normal anatomy and those with aneurysms. Neurosurg Rev. 2013; 36(3): 437–445.
- Schievink WI, Schaid DJ, Rogers HM, et al. On the inheritance of intracranial aneurysms. Stroke. 1994; 25(10): 2028–2037.
- Shojima M, Oshima M, Takagi K, et al. Role of the bloodstream impacting force and the local pressure elevation in the rupture of cerebral aneurysms. Stroke. 2005; 36(9): 1933–1938.
- Soylu Aİ, Ozturk M, Akan H. Can vessel diameters, diameter ratios, and vessel angles predict the development of anterior communicating artery aneurysms: A morphological analysis. J Clin Neurosci. 2019; 68: 250–255.
- Tarulli E, Fox AJ. Potent risk factor for aneurysm formation: termination aneurysms of the anterior communicating artery and detection of A1 vessel asymmetry by flow dilution. Am J Neuroradiol. 2010; 31(7): 1186–1191.
- Taylor CL, Yuan Z, Selman WR, et al. Cerebral arterial aneurysm formation and rupture in 20,767 elderly patients: hypertension and other risk factors. J Neurosurg. 1995; 83(5): 812–819.
- Wardlaw JM, White PM. The detection and management of unruptured intracranial aneurysms. Brain. 2000; 123(2): 205–221.
- Wiebers DO, Whisnant JP, Sundt TM, et al. The significance of unruptured intracranial saccular aneurysms. J Neurosurg. 1987; 66(1): 23–29.
