Middle cerebral arterial bifurcation aneurysms are associated with bifurcation angle and high tortuosity - 20/12/21

Doi : 10.1016/j.neurad.2021.12.001

Xuejing Zhang ^a, Weili Hao ^a, Siqin Han ^b, Chun-Feng Ren ^c, Lei Yang ^a, Yongfeng Han ^a, Bulang Gao ^a,^⁎
^a Department of Medical Research and Neurosurgery, Shijiazhuang People's Hospital, China
^b Hebei Medical University, China
^c Zhengzhou University First Affiliated Hospital, China

^⁎Corresponding author at: Department of Medical Research and Neurosurgery, Shijiazhuang People's Hospital, 9 Fangbei Road, Shijiazhuang, Hebei Province 050011, China.Department of Medical Research and NeurosurgeryShijiazhuang People's Hospital, 9 Fangbei RoadShijiazhuangHebei Province050011China

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Abstract

Purpose

To investigate the association of middle cerebral artery (MCA) bifurcation aneurysms with bifurcation morphology.

Materials and methods

205 patients were enrolled, including 61 patients with MCA bifurcation aneurysms and 144 non-aneurysmal subjects. Aneurysmal cases were divided into types C (aneurysm neck on extension of the parent artery centerline) and D (deviating neck). The radius of the parent artery M1 (R_P) and bilateral branches (R_S and R_L, respectively), smaller (φ_S) and larger (φ_L) lateral angles, bifurcation angle, and arterial tortuosity from parent vessel to bilateral branches (T_S and T_L, respectively) were analyzed. Logistic regression and receiver operator characteristic (ROC) curve analysis were performed to identify risk factors and predictive values for MCA aneurysm presence and types.

Results

In aneurysmal MCA bifurcations, bifurcating angle, T_S, T_L and R_L were significantly larger (P<0.01), while φ_S was significantly smaller (P<0.001) than those in controls. The bifurcation angle, T_S and LogitP were better morphological parameters for predicting MCA aneurysm presence with the AUC of 0.795, 0.932 and 0.951, respectively. Significant (P<0.05) differences were observed in the bifurcation angle, φ_L, R_P, R_L and T_L between types C and D aneurysmal bifurcations. T_L was an independent factor in discriminating types C from D aneurysms with an AUC of 0.802.

Conclusions

Bifurcation angle and arterial tortuosity from the parent artery to the branch forming a smaller angle with the parent artery have a higher value in distinguishing MCA aneurysmal from non-aneurysmal ones, and the tortuosity from the parent artery to the contralateral branch is the best indicator for distinguishing types C from D aneurysmal bifurcations.

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Graphical abstract

Image, graphical abstract

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Highlights

•	MCA bifurcation angle has a higher value in distinguishing MCA aneurysmal from non-aneurysmal bifurcations.
•	Arterial tortuosity from the parent artery to the branch forming a smaller angle with the parent artery has a higher value in distinguishing MCA aneurysmal from non-aneurysmal bifurcations.
•	Arterial tortuosity from the parent artery to the contralateral branch is the best indicator for distinguishing types C from D aneurysmal bifurcations.

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Keywords : Middle cerebral artery, Aneurysm, Arterial tortuosity, Bifurcation angle, Lateral angle

Abbreviations : MCA, ROC, AUC, MRA, DSA, CFD, WSS