Deviation from optimal vascular caliber control at middle cerebral artery bifurcations harboring aneurysms.
Deviation from optimal vascular caliber control at middle cerebral artery bifurcations harboring aneurysms.
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DOI：
10.1016/j.jbiomech.2014.08.012
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发表时间：
2014-10-17
影响因子：
2.4
通讯作者：
Malek, Adel M.
中科院分区：
文献类型：
--
作者：
Baharoglu, Merih I.;Lauric, Alexandra;Wu, Chengyuan;Hippelheuser, James;Malek, Adel M.
脑动脉瘤优先在动脉分叉处形成。血管最优性原理（VOP）规定，跨分叉的最小能量损失需要父分支（r 0）和子分支（r1和r2）半径之间的最优口径控制：r 0 n = r1 n + r2 n，其中n近似为3。VOP需要恒定的壁切应力（WSS），内皮表型调节。我们试图确定颅内分叉处是否能保持口径控制。使用3D梯度边缘检测滤波处理了159个大脑中动脉（MCA）分叉（62个大脑中动脉）的三维旋转血管造影体积，从而实现阈值不敏感的半径测量。使用Student t检验和Wilcoxon秩和分析比较了分叉和非分叉的半径比（RR）= r 03/（r13+r23）和估计的连接指数（n）。结果表明，非对称性分叉显示出最佳的口径控制，平均RR为1.05，中位数n为2.84。相比之下，三叉神经分叉的RR显著较低（0.76，p<.0001），n显著较高（4.28，p<.0001）。出乎意料的是，37%的分叉显示子分支大于其载瘤血管，这绝对违反了最优性，在非分叉中没有观察到。动脉瘤更常起源于较小的子分支（52%），而不是较大的子分支（16%）。动脉瘤大小与RR或n无统计学相关性。动脉瘤男性患者VOP偏离较高。对侧的非对称性MCA分叉显示出最佳的口径控制。与非动脉瘤分叉相反，动脉瘤分叉不服从VOP，并且可能在WSS介导的口径控制中表现出失调。这种焦点偏离最佳状态的机制可能是动脉瘤发病机制的基础，需要进一步研究。
Cerebral aneurysms form preferentially at arterial bifurcations. The vascular optimality principle (VOP) decrees that minimal energy loss across bifurcations requires optimal caliber control between radii of parent (r0) and daughter branches (r1 and r2): r0n=r1n+r2n, with n approximating three. VOP entails constant wall shear stress (WSS), an endothelial phenotype regulator. We sought to determine if caliber control is maintained in aneurysmal intracranial bifurcations. Three-dimensional rotational angiographic volumes of 159 middle cerebral artery (MCA) bifurcations (62 aneurysmal) were processed using 3D gradient edge-detection filtering, enabling threshold-insensitive radius measurement. Radius ratio (RR)=r03/(r13+r23) and estimated junction exponent (n) were compared between aneurysmal and non-aneurysmal bifurcations using Student t-test and Wilcoxon rank-sum analysis. The results show that non-aneurysmal bifurcations display optimal caliber control with mean RR of 1.05 and median n of 2.84. In contrast, aneurysmal bifurcations had significantly lower RR (0.76, p<.0001) and higher n (4.28, p<.0001). Unexpectedly, 37% of aneurysmal bifurcations revealed a daughter branch larger than its parent vessel, an absolute violation of optimality, not witnessed in non-aneurysmal bifurcations. The aneurysms originated more often off the smaller daughter (52%) vs. larger daughter branch (16%). Aneurysm size was not statistically correlated to RR or n. Aneurysmal males showed higher deviation from VOP. Non-aneurysmal MCA bifurcations contralateral to aneurysmal ones showed optimal caliber control. Aneurysmal bifurcations, in contrast to non-aneurysmal counterparts, disobey the VOP and may exhibit dysregulation in WSS-mediated caliber control. The mechanism of this focal divergence from optimality may underlie aneurysm pathogenesis and requires further study.
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