Wall shear stress gradient is independently associated with middle cerebral artery aneurysm development: a case-control CFD patient-specific study based on 77 patients

Zimny, Mikołaj; Kawlewska, E.; Hebda, Anna; Wolański, W.; Ładziński, Piotr; Kaspera, Wojciech

doi:10.1186/s12883-021-02251-3

Cited by 19 publications

(7 citation statements)

References 52 publications

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“…Few studies have been conducted on VBD with BA‐dissecting aneurysms. It is unclear whether the formation of dissecting aneurysms is related to pathological changes in the vessel wall and wall shear stress in patients with VBD [ 2 , 19 , 20 , 21 ]. This needs to be further explored in future research.…”

Section: Discussionmentioning

confidence: 99%

Studying the imaging features and infarction mechanism of vertebrobasilar dolichoectasia with high‐resolution magnetic resonance imaging

et al. 2023

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The mechanisms underlying ischemic infarction in patients with vertebrobasilar dolichoectasia (VBD) remain unclear. In this study, we retrospectively analyzed the imaging characteristics of high‐resolution magnetic resonance imaging (HR‐MRI) in patients with VBD to explore the possible mechanisms of ischemic stroke (IS) in patients with VBD. Patients with VBD were recruited from the HR‐MRI database between July 2017 and June 2021. HR‐MRI was used to evaluate the diameter, bifurcation height, laterality, arterial dissection, and atherosclerotic plaques of the basilar artery (BA). Transcranial Doppler was used to measure the vertebrobasilar mean velocity (Vm), peak systolic velocity (Vs), end‐diastolic velocity (Vd), and pulsatile index. Twenty‐six patients with VBD were enrolled, of which 15 had IS and 11 did not. The incidence of classical vascular risk factors, including age, sex, hypertension, diabetes, and hypercholesterolemia, did not differ significantly between the two groups. The BA diameters of the stroke group were significantly higher than that of the nonstroke group (6.57 ± 1.00 mm vs. 5.06 ± 0.50 mm, p = 0.000). The height of the BA bifurcation in the stroke and nonstroke groups was statistically significant (p = 0.002). Compared with the nonstroke group, the Vm, Vs, and Vd of the BA in the stroke group were lower, but the difference was not significant. In the 16 patients with atherosclerotic stenosis, 30 atherosclerotic plaques were found in the BA, 18 (60%) in the greater curvature, and 12 (40%) in the lesser curvature. In addition, one artery dissection (on the lesser curvature) and two dissecting aneurysms (on the greater curvature) were found in the BA of three patients, respectively. The BA diameter and bifurcation height are factors related to IS in patients with VBD. The mechanism of stroke in patients with VBD may involve abnormal hemodynamics, artery dissection, and atherosclerosis. HR‐MRI is a useful method for evaluating the risk and underlying mechanism of stroke in patients with VBD.

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Section: Discussionmentioning

confidence: 99%

Studying the imaging features and infarction mechanism of vertebrobasilar dolichoectasia with high‐resolution magnetic resonance imaging

et al. 2023

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“…According to the current view on the aetiology of IA, the haemodynamic factor, that is, mainly the magnitude of WSS and its gradient, plays a key role in the formation of aneurysms [10,23]. The results of liquid flow in glass model studies and CFD studies have shown that the geometry of the bifurcation, including the diameter of the vessels forming the bifurcation and the bifurcation angle, plays an important role in the distribution of WSS and turbulence on the bifurcation components [12,13,21,[24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Morphometry of cerebral arterial bifurcations harbouring aneurysms: a case-control study

et al. 2022

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Background Conclusions from studies evaluating vessel dimensions and their deviations from values resulting from the principle of minimum work (PMW) on the formation of intracranial aneurysms (IAs) are still inconclusive. Our study aimed to perform a morphometric analysis of cerebral arterial bifurcations harbouring aneurysms. Methods The study comprised 147 patients with basilar artery (BA) and middle cerebral artery (MCA) aneurysms and 106 patients constituting the control group. The following morphometric parameters were evaluated: the radii of vessels forming the bifurcation, the junction exponent, the values of the bifurcation angles (Φ1 and Φ2 angles between the parent vessel trunk axis and the larger or smaller branches, respectively; α angle, the total bifurcation angle) and the difference between the predicted optimal and observed branch angles. Results The analysed parameters for internal carotid artery (ICA) bifurcations were not significantly different among the groups. The MCA and BA bifurcation angles and the radii of the parent MCA and BA vessels with aneurysms were significantly higher than those of the control group. The differences between the predicted optimal and observed branch angles were significantly higher for BA and MCA bifurcations with aneurysms compared to the control group. The mean junction exponent for bifurcations in the circle of Willis (i.e., ICA and BA bifurcations, respectively) and MCA bifurcations with aneurysms was significantly lower than the theoretical optimum and did not significantly differ among the groups. In a multilevel multivariate logistic regression analysis, the branch angles and the radius from the parent vessel were significant independent predictors of the presence of an IA. The ROC analysis indicated that the α angle was the best performer in discriminating between aneurysmal and nonaneurysmal bifurcations. Conclusions The dimensions of the arteries forming the circle of Willis do not follow the PMW. Deviation from the energetically optimum geometry for bifurcations beyond the circle of Willis (particularly, a larger radius of the parent artery and a wider total bifurcation angle) may lead to the formation of IAs. Further studies are warranted to investigate the significance of vessel dimensions and the bifurcation angle on the magnitude of shear stress in the walls of arterial bifurcations.

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“…According to the current view on the aetiology of IAs, the haemodynamic factor, that is, mainly the magnitude of WSS and its gradient, plays a key role in the formation of aneurysms (10,23).…”

Section: Discussionmentioning

confidence: 99%

Morphometry of Cerebral Arterial Bifurcations Harbouring Aneurysms: A Case-Control Study On 253 Patients

Ćmiel-Smorzyk

Kawlewska

Wolański

et al. 2021

Preprint

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Background Conclusions from studies evaluating vessel dimensions and their deviations from the values resulting from the principle of minimum work (PMW) on the formation of intracranial aneurysms (IAs) are still inconclusive. The aim of our study was the morphometric analysis of cerebral arterial bifurcations harbouring aneurysms. Methods The study comprised 147 patients with basilar artery (BA) and middle cerebral artery (MCA) aneurysms, and 106 patients constituting the control group. The following morphometric parameters were evaluated: the radii of vessels forming the bifurcation, the junction exponent, the values of the bifurcation angles (Φ1 and Φ2 angles between the parent vessel trunk axis and the larger or smaller branches, respectively; α angle, total bifurcation angle) and the difference between the predicted optimal and observed branch angles. Results The analysed parameters for internal carotid artery (ICA) bifurcations were not significantly different among the groups. MCA and BA bifurcation angles and the radii of the parent MCA and BA vessels with aneurysms were significantly higher compared to the control group. The differences between the predicted optimal and observed branch angles were significantly higher for BA and MCA bifurcations with aneurysms compared to the control group. The mean junction exponent for bifurcations in the circle of Willis (i.e., ICA and BA bifurcations, respectively) and MCA bifurcations with aneurysms was significantly lower than the theoretical optimum and not significantly different among the groups. In a multilevel multivariate logistic regression analysis, the branch angles and the radius from the parent vessel were significant independent predictors of the presence of IAs. The ROC analysis indicated that the α angle was the best performer in discriminating between aneurysmal and non-aneurysmal bifurcations. Conclusions The dimensions of the arteries forming the circle of Willis do not follow the PMW. The deviation from optimum bifurcation geometry for bifurcations beyond the circle of Willis (particularly a wider radius of the parent artery and a wider total bifurcation angle) may lead to the formation of IAs. Further studies are warranted to investigate the significance of vessel dimensions and the bifurcation angle on the magnitude of the shear stress in the walls of arterial bifurcations.

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Wall shear stress gradient is independently associated with middle cerebral artery aneurysm development: a case-control CFD patient-specific study based on 77 patients

Cited by 19 publications

References 52 publications

Studying the imaging features and infarction mechanism of vertebrobasilar dolichoectasia with high‐resolution magnetic resonance imaging

Studying the imaging features and infarction mechanism of vertebrobasilar dolichoectasia with high‐resolution magnetic resonance imaging

Morphometry of cerebral arterial bifurcations harbouring aneurysms: a case-control study

Morphometry of Cerebral Arterial Bifurcations Harbouring Aneurysms: A Case-Control Study On 253 Patients

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