Increased tortuosity of ACA might be associated with increased risk of ACoA aneurysm development and less aneurysm dome size: a computer-aided analysis

Abstract

ObjectivesWe decided to perform computer-aided analysis of the anterior cerebral artery (ACA) to check for a potential correlation with anterior communicating artery (ACoA) aneurysm presence and growth.MethodsWe retrospectively analyzed the ACA anatomy of 121 patients with ACoA aneurysms along with 121 age, risk factors, and vessel side-matched control patients without an ACoA aneurysm. We obtained their medical history and digital subtraction angiography (DSA) data from their medical records. For each patient’s DSA, we extracted curve representing the course of their ACA and calculated its relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD), and inflection count metrics (ICM).ResultsPatients with ACoA aneurysm had significantly higher RL (0.64 ± 0.23 vs. 0.56 ± 0.22; p < 0.01), SOAM (0.27 ± 0.19 vs. 0.18 ± 0.15; p < 0.01), PAD (0.12 ± 0.13 vs. 0.09 ± 0.11; p = 0.02), and TI (0.57 ± 0.14 vs. 0.44 ± 0.15; p < 0.01). In multivariate logistic regression analysis, after adjustment for possible confounders, SOAM (OR, 1.34; 95% CI, 1.12–1.63; p < 0.01) and TI (OR, 1.84; 95% CI, 1.47–2.35; p < 0.01) remained independently associated with higher risk of ACoA aneurysm. Additionally, we found significant negative correlations between TI and aneurysm dome size (R = − 0.194; p = 0.047).ConclusionsIncreased tortuosity of ACA might increase the risk of ACoA aneurysm development and decrease the risk of aneurysm growth.Key Points • Anterior cerebral artery’s sum of angle metrics is associated with hypertension as well as with history of ischemic stroke and myocardial infarction. • Increased tortuosity of anterior cerebral artery might be associated with anterior communicating artery aneurysm development. • Tortuosity of anterior cerebral artery is negatively correlated with anterior communicating artery aneurysm dome size.

Increased tortuosity of basilar artery might be associated with higher risk of aneurysm development

“…An interesting finding of this and our previous studies, in which we analysed tortuosity of MCA, ACA and ICA [12][13][14]25], are differences in contribution of certain tortuosity descriptors to risk of aneurysm development. For all four arteries, we found that increased values of TI were associated with higher risk of aneurysm presence.…”

“…It was shown before for aortic [10] and splenic artery [11] aneurysms. In terms of other cerebral vessels, a similar association was found for ICA [14,23], MCA [12], ACoA [13] and VA [24]. Additionally, increased tortuosity was associated with lower risk of intracranial aneurysm rupture [25] and inversely correlated with its size [13].…”

“…In terms of other cerebral vessels, a similar association was found for ICA [14,23], MCA [12], ACoA [13] and VA [24]. Additionally, increased tortuosity was associated with lower risk of intracranial aneurysm rupture [25] and inversely correlated with its size [13]. The association of higher tortuosity with aneurysm development most likely results from weakening of the arterial wall.…”

“…In other studies, higher tortuosity was linked to aortic aneurysm presence and risk of rupture [10], as well as to development of splenic artery aneurysm [11]. In our previous study, we have also proved that aneurysms of the middle cerebral artery (MCA) [12], anterior communicating artery (ACA) [13] and internal carotid artery (ICA) [14] are also linked to its tortuosity. However, these associations differed in terms of all used tortuosity descriptors.…”

How Cerebral Vessel Tortuosity Affects Development and Recurrence of Aneurysm: Outer Curvature versus Bifurcation Type

“…Studies have investigated the effects of vessel tortuosity on the outcome of IA, and the relationship between tortuosity and rupture risk is debated. 9,11,12,26 Abdominal aortic tortuosity increases the risk of abdominal aortic aneurysm rupture. 27 Ryu et A B C D al.…”