Widening and High Inclination of the Middle Cerebral Artery Bifurcation Are Associated With Presence of Aneurysms

BACKGROUND AND PURPOSE—The middle cerebral artery (MCA) bifurcation is a preferred site for aneurysm formation. Wider bifurcation 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 bifurc...

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Bibliographic Details
Published in:Stroke (1970) 2014-09, Vol.45 (9), p.2649-2655
Main Authors: Baharoglu, Merih I, Lauric, Alexandra, Safain, Mina G, Hippelheuser, James, Wu, Chengyuan, Malek, Adel M
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Aneurysm, Ruptured - diagnostic imaging
Biological and medical sciences
Cerebral Angiography - methods
Cerebral circulation. Blood-brain barrier. Choroid plexus. Cerebrospinal fluid. Circumventricular organ. Meninges
Disease Progression
Female
Fundamental and applied biological sciences. Psychology
Humans
Imaging, Three-Dimensional
Intracranial Aneurysm - diagnostic imaging
Male
Medical sciences
Middle Aged
Middle Cerebral Artery - diagnostic imaging
Middle Cerebral Artery - physiopathology
Neurology
Radiographic Image Interpretation, Computer-Assisted
Retrospective Studies
Risk Factors
ROC Curve
Treatment Outcome
Vascular diseases and vascular malformations of the nervous system
Vertebrates: nervous system and sense organs
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Summary:BACKGROUND AND PURPOSE—The middle cerebral artery (MCA) bifurcation is a preferred site for aneurysm formation. Wider bifurcation 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. METHODS—Three-dimensional rotational angiography volumes of 146 MCA bifurcations (62 aneurysmal) were evaluated for angle morphologyparent–daughter angles (larger daughter Ф1, smaller daughter Ф2), bifurcation angle (Ф1+Ф2), and inclination angle (γ) between the parent vessel axis and the plane determined by daughter vessel axes. Statistics were evaluated using Wilcoxon rank-sum analysis and area under the receiver operator characteristic curve. RESULTS—Aneurysmal bifurcations had wider inclination angle γ (median 57.8° versus 15.4°; P10°, compared with 25% nonaneurysmal. Ф1 and Ф2, but especially Ф1+Ф2, were significantly larger in aneurysmal bifurcations (median 171.3° versus 98.1°; P161°, compared with 0% nonaneurysmal MCAs. An optimal threshold of 140° was established for Ф1+Ф2 (area under the curve, 0.98). Sixty-eight percent of aneurysms originated off the daughter branches. Seventy-six percent of them originated off the branch with the largest branching angle, specifically if this was the smaller daughter branch. Wider Ф1+Ф2 correlated with aneurysm neck width, but not dome size. CONCLUSIONS—MCA bifurcations harboring aneurysms have significantly larger branching angles and more often originate off the branch with the largest angle. Wider inclination angle is strongly correlated with aneurysm presence, a novel finding. The results point to altered wall shear stress regulation as a possible factor in aneurysm development and progression.
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.114.005393