Critical Pressure for Arterial Wall Rupture in Major Human Cerebral Arteries

Abstract

Background and Purpose— Intracranial bleeding is linked to hemodynamic stress factors, such as hypertension. However, there are no studies that tested the breaking pressure of normal large cerebral arteries in humans. Methods— The brains of 10 cadavers (age, 47±14 years; 9 men) were harvested within 48 hours postmortem for 31 segments of the main intracranial arteries. After careful microsurgical preparation, the vessels were pressurized with saline and observed until they ruptured. Results— Vessel diameters averaged 2.6±0.3 mm (range, 1.2–4.3 mm). The average rupture pressure was 2.21±0.59 atm (range, 1.13–4.3 atm) and decreased with age at −0.025 atm/y ( R 2 =40%; P <0.0002). The maximum diameter distention at rupture was 30±9% (13%–52%), which also decreased with age (−0.5%/y; R 2 =78%; P <0.00001). Neither the rupture pressure nor the maximum distention showed significant dependence on the resting vessel diameter. No significant dependencies were found on the vessel origin, vascular configuration, direction of the rupture, or the presence of minor coexisting pathology. Conclusions— Human cerebral arterial wall breaks only at extremely high intravascular pressures, exceeding several times the highest observed systolic blood pressure, even accounting for age trends. Systolic hypertension alone may not be sufficient to cause intracranial hemorrhage, and there may be additional contributing factors.

Experimental determination of rupture pressure and stress of adventitia of human middle cerebral arteries

“…Age dependence and the range of rupture pressure values of intact wall M1 segments, shown in Figure 3, agree well with those reported by Ciszek et al. 7 The general tendency of decreasing mechanical strength with age is consistent with the structural changes of the cerebral arterial layers. 8 The same observation has been reported for thoracic and abdominal aorta by Wuyts et al.…”

Experimental Study of Rupture Pressure and Elasticity of Abdominal Aortic Aneurysms Found at Autopsy

“…The findings suggest that, in an aorta presenting an aneurysm, the vessel's dilated portions are not necessarily weaker than the segments with normal diameter. Ciszek et al 6 in their biomechanical study of cerebral arteries' resistance against pressurization had similar result: only one of the two cerebral aneurysms included in their casuistic evolved to rupture in the dilated part of the vessel.…”

“…Ciszek et al 6 (2013) investigated the biomechanical behavior of cerebral arteries' segments (aneurysm n ¼ 2), pressurizing these vessels up to their rupture. Similarly, the present study's primary aim is to submit cadaveric whole abdominal aortic specimens to an inflation experiment up to their rupture, observing the maximum pressure they could endure.…”

Ex Vivo and in Silico Study of Human Common Carotid Arteries Pressure Response in Physiological and Inverted State

“…An specially constructed apparatus was used to carry out pressure-inflation tests on arteries. The experimental procedure was similar to the one described by Ciszek et al (2013). Shortly, just after extraction, the tissues were immersed in 0.9% physiological saline solution.…”