Relationship between middle cerebral parent artery asymmetry and middle cerebral artery aneurysm rupture risk factors

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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.

ABBREVIATIONS ICA = internal carotid artery; IM = ICA/M1; MCA = middle cerebral artery.
Article Information

Contributor Notes

Correspondence Nicholas C. Bambakidis: University Hospitals Cleveland Medical Center, Cleveland, OH. nicholas.bambakidis2@uhhospitals.org.INCLUDE WHEN CITING Published online March 29, 2019; DOI: 10.3171/2018.12.JNS182951.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Augsburger LReymond PFonck EKulcsar ZFarhat MOhta M: Methodologies to assess blood flow in cerebral aneurysms: current state of research and perspectives. J Neuroradiol 36:2702772009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Byun JSChoi SYSeo T: The numerical study of the hemodynamic characteristics in the patient-specific intracranial aneurysms before and after surgery. Comput Math Methods Med 2016:43845082016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Can AHo ALDammers RDirven CMFDu R: Morphological parameters associated with middle cerebral artery aneurysms. Neurosurgery 76:7217272015

  • 4

    Castro MAPutman CMCebral JR: Computational fluid dynamics modeling of intracranial aneurysms: effects of parent artery segmentation on intra-aneurysmal hemodynamics. AJNR Am J Neuroradiol 27:170317092006

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Cebral JRCastro MABurgess JEPergolizzi RSSheridan MJPutman CM: Characterization of cerebral aneurysms for assessing risk of rupture by using patient-specific computational hemodynamics models. AJNR Am J Neuroradiol 26:255025592005

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Chien ASayre JViñuela F: Comparative morphological analysis of the geometry of ruptured and unruptured aneurysms. Neurosurgery 69:3493562011

  • 7

    Flores BCScott WWEddleman CSBatjer HHRickert KL: The A1–A2 diameter ratio may influence formation and rupture potential of anterior communicating artery aneurysms. Neurosurgery 73:8458532013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Groen DRichardson RACoy RSchiller UDChandrashekar HRobertson F: Validation of patient-specific cerebral blood flow simulation using transcranial Doppler measurements. Front Physiol 9:7212018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Hackenberg KAMHanggi DEtminan N: Unruptured intracranial aneurysms: contemporary data and management. Stroke 49:226822752018

  • 10

    Ingebrigtsen TMorgan MKFaulder KIngebrigtsen LSparr TSchirmer H: Bifurcation geometry and the presence of cerebral artery aneurysms. J Neurosurg 101:1081132004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Isaksen JGBazilevs YKvamsdal TZhang YKaspersen JHWaterloo K: Determination of wall tension in cerebral artery aneurysms by numerical simulation. Stroke 39:317231782008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Isoda HHirano MTakeda HKosugi TAlley MTMarkl M: Visualization of hemodynamics in a silicon aneurysm model using time-resolved, 3D, phase-contrast MRI. AJNR Am J Neuroradiol 27:111911222006

    • Search Google Scholar
    • Export Citation
  • 13

    Kim DWKang SD: Association between internal carotid artery morphometry and posterior communicating artery aneurysm. Yonsei Med J 48:6346382007

  • 14

    Kliś KMKrzyżewski RMKwinta BMStachura KMoskała MTomaszewski KA: Computer-aided analysis of middle cerebral artery tortuosity: association with aneurysm development. J Neurosurg 18:172018

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Ku DN: Blood flow in arteries. Annu Rev Fluid Mech 29:3994341997

  • 16

    Lindgren AEKoivisto TBjörkman Jvon und zu Fraunberg MHelin KJääskeläinen JE: Irregular shape of intracranial aneurysm indicates rupture risk irrespective of size in a population-based cohort. Stroke 47:121912262016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Longo MGranata FRacchiusa SMormina EGrasso GLongo GM: Role of hemodynamic forces in unruptured intracranial aneurysms: an overview of a complex scenario. World Neurosurg 105:6326422017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Matsukawa HFujii MAkaike GUemura ATakahashi ONiimi Y: Morphological and clinical risk factors for posterior communicating artery aneurysm rupture. J Neurosurg 120:1041102014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Meng HTutino VMXiang JSiddiqui A: High WSS or low WSS? Complex interactions of hemodynamics with intracranial aneurysm initiation, growth, and rupture: toward a unifying hypothesis. AJNR Am J Neuroradiol 35:125412622014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Munarriz PMGómez PAParedes ICastaño-Leon AMCepeda SLagares A: Basic principles of hemodynamics and cerebral aneurysms. World Neurosurg 88:3113192016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Rinaldo LMcCutcheon BAMurphy MEBydon MRabinstein AALanzino G: Relationship of A1 segment hypoplasia to anterior communicating artery aneurysm morphology and risk factors for aneurysm formation. J Neurosurg 127:89952017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Shalaby AI: Fluid Mechanics for Civil and Environmental Engineers. Boca Raton: CRC Press2018

  • 23

    Tarulli EFox AJ: Potent risk factor for aneurysm formation: termination aneurysms of the anterior communicating artery and detection of A1 vessel asymmetry by flow dilution. AJNR Am J Neuroradiol 31:118611912010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Valen-Sendstad KMardal KASteinman DA: High-resolution CFD detects high-frequency velocity fluctuations in bifurcation, but not sidewall, aneurysms. J Biomech 46:4024072013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Vlak MHAlgra ABrandenburg RRinkel GJ: Prevalence of unruptured intracranial aneurysms, with emphasis on sex, age, comorbidity, country, and time period: a systematic review and meta-analysis. Lancet Neurol 10:6266362011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Weir BAmidei CKongable GFindlay JMKassell NFKelly J: The aspect ratio (dome/neck) of ruptured and unruptured aneurysms. J Neurosurg 99:4474512003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Yu MHuang QHong BQiao FLiu J: Morphological differences between the aneurysmal and normal artery in patients with internal carotid-posterior communicating artery aneurysm. J Clin Neurosci 17:139513982010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Zamir M: The Physics of Pulsatile Flow. New York: Springer2000

  • 29

    Zegers ESMeursing BTJZegers EBOude Ophuis AJM: Coronary tortuosity: a long and winding road. Neth Heart J 15:1911952007

  • 30

    Zhang JCan AMukundan S JrSteigner MCastro VMDligach D: Morphological variables associated with ruptured middle cerebral artery aneurysms. Neurosurgery [epub ahead of print] 2018

    • PubMed
    • Search Google Scholar
    • Export Citation
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