Widening and high inclination of the middle cerebral artery bifurcation are associated with presence of aneurysms.
Widening and high inclination of the middle cerebral artery bifurcation are associated with presence of aneurysms.
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DOI：
10.1161/strokeaha.114.005393
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发表时间：
2014-09
期刊：
影响因子：
8.3
通讯作者：
Malek AM
中科院分区：
文献类型：
--
作者：
Baharoglu MI;Lauric A;Safain MG;Hippelheuser J;Wu C;Malek AM
大脑中动脉（MCA）分叉处是动脉瘤形成的首选部位。较宽的分叉角度与动脉瘤形成的风险增加相关。我们假设 MCA 动脉瘤的存在与分叉的角度形态之间存在联系。对 146 个 MCA 分叉（62 个动脉瘤）的 3D 旋转血管造影体积进行角度形态评估：母体-子体角度（较大的子体 - Φ1，较小的子体 - Φ2）、分叉角 (Φ1+Φ2) 以及母体血管轴与子体血管轴确定的平面之间的倾斜角 (γ)。使用 Wilcoxon 秩和分析和 ROC 曲线下面积 (AUC) 评估统计数据。动脉瘤分叉具有更宽的倾斜角 γ（中位 57.8° 对比 15.4°；p<0.0001）。 75% 的动脉瘤性 MCA γ>10°，而非动脉瘤性 MCA 的比例为 25%。 Φ1、Φ2，尤其是 Φ1+Φ2 在动脉瘤分叉处显着更大（中位角 171.3° 对比 98.1°；p<0.0001）。 67% 的动脉瘤性分叉具有 Φ1+Φ2>161°，而非动脉瘤性 MCA 的比例为 0%。 Φ1+Φ2 的最佳阈值为 140°（AUC=0.98）。 68% 的动脉瘤起源于子分支。其中 76% 源自分枝角度最大的分支，特别是如果这是较小的子分支。较宽的 Φ1+Φ2 与动脉瘤颈宽度相关，但与瘤顶大小无关。含有动脉瘤的 MCA 分叉具有明显更大的分支角度，并且更经常起源于具有最大角度的分支。较宽的倾斜角度与动脉瘤的存在密切相关，这是一项新发现。结果表明，WSS 调节的改变可能是动脉瘤发生和进展的一个因素。
The middle cerebral artery (MCA) bifurcation is a preferred site for aneurysm formation. Wider bifurcations angles have been correlated with increased risk of aneurysm formation. We hypothesized a link between the presence of MCA aneurysms and the angle morphology of the bifurcation. 3D rotational angiography volumes of 146 MCA bifurcations (62 aneurysmal) were evaluated for angle morphology: parent-daughter angles (larger daughter-Φ1, smaller daughter-Φ2), bifurcation angle (Φ1+Φ2), and inclination angle (γ) between the parent vessel axis and the plane determined by daughter vessels axes. Statistics were evaluated using Wilcoxon rank-sum analysis and area under the ROC curve (AUC). Aneurysmal bifurcations had wider inclination angle γ (median 57.8° vs. 15.4°; p<0.0001). 75% of aneurysmal MCAs had γ>10°, compared to 25% non-aneurysmal. Φ1, Φ2, but especially Φ1+Φ2 were significantly larger in aneurysmal bifurcations (median 171.3° vs. 98.1°; p<0.0001). 67% of aneurysmal bifurcations had Φ1+Φ2>161°, compared to 0% non-aneurysmal MCAs. An optimal threshold of 140° was established for Φ1+Φ2 (AUC=0.98). 68% of aneurysms originating off the daughter branches. 76% of them originated off the branch with the largest branching angle, specifically if this was the smaller daughter branch. Wider Φ1+Φ2 correlated with aneurysm neck width, but not dome size. MCA bifurcations harboring aneurysms have significantly larger branching angles, and more often originate off of the branch with the largest angle. Wider inclination angle is strongly correlated with aneurysm presence, a novel finding. The results point to altered WSS regulation as a possible factor in aneurysm development and progression.