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.
Highlights
ObjectivesThe aim of our study was to verify whether arterial bifurcations in patients with cerebral aneurysm differ in terms of their morphology and selected hemodynamic parameters from the bifurcations in non-aneurysmal controls
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 principle of minimum work (PMW)-derived optimum
The exclusion criteria from the study were: age under 18 years or over 75 years, presence of multiple cerebral aneurysms or other than aneurysm pathologies in the central nervous system that could have a potential effect on cerebral blood flow, severe systemic disorders, severe heart failure or multi-organ failure, hemodynamically significant stenosis of the extracranial segment of the internal carotid artery (ICA), pregnancy and family history of cerebral aneurysm or genetically determined conditions associated with increased risk of cerebral aneurysm development, such as autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and type II and type IV Ehlers-Danlos syndrome
Summary
The aim of our study was to verify whether arterial bifurcations in patients with cerebral aneurysm differ in terms of their morphology and selected hemodynamic parameters from the bifurcations in non-aneurysmal controls
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