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<meta name="DC.Title" content="Potent Risk Factor for Aneurysm Formation: Termination Aneurysms of the Anterior Communicating Artery and Detection of A1 Vessel Asymmetry by Flow Dilution" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2065" />
<meta name="DC.Date" content="2010-08-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: There is a high incidence of intracranial aneurysms of the AcomA suggesting the possibility of an anatomic risk factor. There also exists an association of termination-type aneurysms with anatomic variations of 1 anterior cerebral artery trunk (A1) as the exclusive or dominant supply to both pericallosal arteries (A2). This yields the hypotheses of aneurysm formation from straight jets of A1 blood.

MATERIALS AND METHODS: The anatomy and contrast filling of A1 and A2 segments and AcomAs were studied for a subset of cases entered into the Cerecyte Coil Trial for patients with AcomA ( n = 105) and other aneurysms ( n = 123) that were selected from imaging available at the Cerecyte Core Trial angiographic Core Lab. These cases were analyzed for A1 vessel dominance by measurement of the vessel diameter and dilution of angiographic contrast agent in A2s due to the differential flow source on selective angiography. A control group without aneurysms was assessed anatomically, using a large sequential CTA series ( n = 159), acquired during acute stroke assessment.

RESULTS: A1 dominance configuration is strongly associated with the presence of AcomA aneurysms for patients with intracranial aneurysms (odds ratio, 17.8). This association is also present compared with the incidence of A1 dominance in the large sequential control series of patients without aneurysms undergoing CTA for other reasons (odds ratio, 7.5). Outflow dilution of selective angiographic images augments anatomic information.

CONCLUSIONS: A flow-based assessment of contrast flowing from the A1 to the A2 segments after injection pressure is superior to an A1 diameter based categorization when A1 vessel diameters are not strikingly different. The anatomic variant of asymmetric A1 configurations likely facilitates the development of AcomA aneurysms by flow stresses, providing further evidence to support the role of biophysical factors in intracranial aneurysm development.

AcomA
:   anterior communicating artery
A1
:   anterior cerebral artery trunk
A2
:   pericallosal artery
CI
:   confidence interval
CTA
:   CT angiography
DSA
:   digital subtraction angiography
ICA
:   internal carotid artery
MRA
:   MR angiography" />
<meta name="DC.Contributor" content="E. Tarulli" />
<meta name="DC.Contributor" content="A.J. Fox" />
<meta name="article:published_time" content="2010-08-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Potent Risk Factor for Aneurysm Formation: Termination Aneurysms of the Anterior Communicating Artery and Detection of A1 Vessel Asymmetry by Flow Dilution" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;There is a high incidence of intracranial aneurysms of the AcomA suggesting the possibility of an anatomic risk factor. There also exists an association of termination-type aneurysms with anatomic variations of 1 anterior cerebral artery trunk (A1) as the exclusive or dominant supply to both pericallosal arteries (A2). This yields the hypotheses of aneurysm formation from straight jets of A1 blood.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;The anatomy and contrast filling of A1 and A2 segments and AcomAs were studied for a subset of cases entered into the Cerecyte Coil Trial for patients with AcomA (&lt;i&gt;n&lt;/i&gt; = 105) and other aneurysms (&lt;i&gt;n&lt;/i&gt; = 123) that were selected from imaging available at the Cerecyte Core Trial angiographic Core Lab. These cases were analyzed for A1 vessel dominance by measurement of the vessel diameter and dilution of angiographic contrast agent in A2s due to the differential flow source on selective angiography. A control group without aneurysms was assessed anatomically, using a large sequential CTA series (&lt;i&gt;n&lt;/i&gt; = 159), acquired during acute stroke assessment.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;A1 dominance configuration is strongly associated with the presence of AcomA aneurysms for patients with intracranial aneurysms (odds ratio, 17.8). This association is also present compared with the incidence of A1 dominance in the large sequential control series of patients without aneurysms undergoing CTA for other reasons (odds ratio, 7.5). Outflow dilution of selective angiographic images augments anatomic information.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;A flow-based assessment of contrast flowing from the A1 to the A2 segments after injection pressure is superior to an A1 diameter based categorization when A1 vessel diameters are not strikingly different. The anatomic variant of asymmetric A1 configurations likely facilitates the development of AcomA aneurysms by flow stresses, providing further evidence to support the role of biophysical factors in intracranial aneurysm development.&lt;/p&gt;" />
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<meta name="twitter:title" content="Potent Risk Factor for Aneurysm Formation: Termination Aneurysms of the Anterior Communicating Artery and Detection of A1 Vessel Asymmetry by Flow Dilution" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: There is a high incidence of intracranial aneurysms of the AcomA suggesting the possibility of an anatomic risk factor. There also exists an association of termination-type aneurysms with anatomic variations of 1 anterior cerebral artery trunk (A1) as the exclusive or dominant supply to both pericallosal arteries (A2). This yields the hypotheses of aneurysm formation from straight jets of A1 blood.

MATERIALS AND METHODS: The anatomy and contrast filling of A1 and A2 segments and AcomAs were studied for a subset of cases entered into the Cerecyte Coil Trial for patients with AcomA ( n = 105) and other aneurysms ( n = 123) that were selected from imaging available at the Cerecyte Core Trial angiographic Core Lab. These cases were analyzed for A1 vessel dominance by measurement of the vessel diameter and dilution of angiographic contrast agent in A2s due to the differential flow source on selective angiography. A control group without aneurysms was assessed anatomically, using a large sequential CTA series ( n = 159), acquired during acute stroke assessment.

RESULTS: A1 dominance configuration is strongly associated with the presence of AcomA aneurysms for patients with intracranial aneurysms (odds ratio, 17.8). This association is also present compared with the incidence of A1 dominance in the large sequential control series of patients without aneurysms undergoing CTA for other reasons (odds ratio, 7.5). Outflow dilution of selective angiographic images augments anatomic information.

CONCLUSIONS: A flow-based assessment of contrast flowing from the A1 to the A2 segments after injection pressure is superior to an A1 diameter based categorization when A1 vessel diameters are not strikingly different. The anatomic variant of asymmetric A1 configurations likely facilitates the development of AcomA aneurysms by flow stresses, providing further evidence to support the role of biophysical factors in intracranial aneurysm development.

AcomA
:   anterior communicating artery
A1
:   anterior cerebral artery trunk
A2
:   pericallosal artery
CI
:   confidence interval
CTA
:   CT angiography
DSA
:   digital subtraction angiography
ICA
:   internal carotid artery
MRA
:   MR angiography" />
<meta name="og-title" property="og:title" content="Potent Risk Factor for Aneurysm Formation: Termination Aneurysms of the Anterior Communicating Artery and Detection of A1 Vessel Asymmetry by Flow Dilution" />
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<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: There is a high incidence of intracranial aneurysms of the AcomA suggesting the possibility of an anatomic risk factor. There also exists an association of termination-type aneurysms with anatomic variations of 1 anterior cerebral artery trunk (A1) as the exclusive or dominant supply to both pericallosal arteries (A2). This yields the hypotheses of aneurysm formation from straight jets of A1 blood.

MATERIALS AND METHODS: The anatomy and contrast filling of A1 and A2 segments and AcomAs were studied for a subset of cases entered into the Cerecyte Coil Trial for patients with AcomA ( n = 105) and other aneurysms ( n = 123) that were selected from imaging available at the Cerecyte Core Trial angiographic Core Lab. These cases were analyzed for A1 vessel dominance by measurement of the vessel diameter and dilution of angiographic contrast agent in A2s due to the differential flow source on selective angiography. A control group without aneurysms was assessed anatomically, using a large sequential CTA series ( n = 159), acquired during acute stroke assessment.

RESULTS: A1 dominance configuration is strongly associated with the presence of AcomA aneurysms for patients with intracranial aneurysms (odds ratio, 17.8). This association is also present compared with the incidence of A1 dominance in the large sequential control series of patients without aneurysms undergoing CTA for other reasons (odds ratio, 7.5). Outflow dilution of selective angiographic images augments anatomic information.

CONCLUSIONS: A flow-based assessment of contrast flowing from the A1 to the A2 segments after injection pressure is superior to an A1 diameter based categorization when A1 vessel diameters are not strikingly different. The anatomic variant of asymmetric A1 configurations likely facilitates the development of AcomA aneurysms by flow stresses, providing further evidence to support the role of biophysical factors in intracranial aneurysm development.

AcomA
:   anterior communicating artery
A1
:   anterior cerebral artery trunk
A2
:   pericallosal artery
CI
:   confidence interval
CTA
:   CT angiography
DSA
:   digital subtraction angiography
ICA
:   internal carotid artery
MRA
:   MR angiography" />
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    <title>Potent Risk Factor for Aneurysm Formation: Termination Aneurysms of the Anterior Communicating Artery and Detection of A1 Vessel Asymmetry by Flow Dilution | American Journal of Neuroradiology</title>  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">E. Tarulli</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a> and </li><li class="last" id="contrib-2"><span class="name">A.J. Fox</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">a</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Neuroradiology Division, Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Emidio Tarulli, MD candidate, MHSc., <span class="addr-line">Queen's University School of Medicine, Undergraduate Medical Education, 68 Barrie St, Kingston, ON, Canada K7L 3N6</span>; email: <span class="em-link"><span class="em-addr">e.tarulli{at}utoronto.ca</span></span> or <span class="em-link"><span class="em-addr">tarulli{at}gmail.com</span></span></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/7/1186.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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