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<meta name="HW.identifier" content="/ajnr/early/2020/06/18/ajnr.A6615.atom" />
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<meta name="DC.Title" content="A Hemodynamic Mechanism Correlating with the Initiation of MCA Bifurcation Aneurysms" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6615" />
<meta name="DC.Date" content="2020-06-18" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Previous studies have reported that MCA bifurcation aneurysms usually emerge on inclined bifurcations; however, the reason is unclear. We designed this study to explore hemodynamic mechanisms that correlate with the initiation of MCA bifurcation aneurysms.

MATERIALS AND METHODS: Fifty-four patients with unilateral MCA bifurcation aneurysms and 54 control patients were enrolled in this study after propensity score matching, and their clinical and CTA data were collected. We extracted the morphologic features of aneurysmal MCA bifurcations to build a simplified MCA bifurcation model and performed a computational fluid dynamics analysis.

RESULTS: The presence of MCA aneurysms correlated with smaller parent-daughter angles of MCA bifurcations ( P  &lt; .001). Aneurysmal MCA bifurcations usually presented with inclined shapes. The computational fluid dynamics analysis demonstrated that when arterial bifurcations became inclined, the high-pressure regions and low wall shear stress regions shifted from the apexes of the arterial bifurcations to the inclined daughter arteries, while the initial sites of MCA bifurcation aneurysms often overlapped with the shifted high-pressure regions and low wall shear stress regions.

CONCLUSIONS: Our results suggest that the initiation of MCA bifurcation aneurysms may correlate with shifts of high-pressure regions and low wall shear stress regions that occur on inclined MCA bifurcations.

CFD
:   computational fluid dynamics
HPR
:   high-pressure region
LWSS
:   low wall shear stress
LWSSR
:   low wall shear stress region
PSM
:   propensity score matching
RD
:   ratio of diameter
ROC
:   receiver operating characteristic" />
<meta name="DC.Contributor" content="Z. Huang" />
<meta name="DC.Contributor" content="M. Zeng" />
<meta name="DC.Contributor" content="W.G. Tao" />
<meta name="DC.Contributor" content="F.Y. Zeng" />
<meta name="DC.Contributor" content="C.Q. Chen" />
<meta name="DC.Contributor" content="L.B. Zhang" />
<meta name="DC.Contributor" content="F.H. Chen" />
<meta name="article:published_time" content="2020-06-18" />
<meta name="article:section" content="INTERVENTIONAL" />
<meta name="citation_title" content="A Hemodynamic Mechanism Correlating with the Initiation of MCA Bifurcation Aneurysms" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Previous studies have reported that MCA bifurcation aneurysms usually emerge on inclined bifurcations; however, the reason is unclear. We designed this study to explore hemodynamic mechanisms that correlate with the initiation of MCA bifurcation aneurysms.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Fifty-four patients with unilateral MCA bifurcation aneurysms and 54 control patients were enrolled in this study after propensity score matching, and their clinical and CTA data were collected. We extracted the morphologic features of aneurysmal MCA bifurcations to build a simplified MCA bifurcation model and performed a computational fluid dynamics analysis.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The presence of MCA aneurysms correlated with smaller parent-daughter angles of MCA bifurcations (&lt;i&gt;P &lt;/i&gt;&amp;lt; .001). Aneurysmal MCA bifurcations usually presented with inclined shapes. The computational fluid dynamics analysis demonstrated that when arterial bifurcations became inclined, the high-pressure regions and low wall shear stress regions shifted from the apexes of the arterial bifurcations to the inclined daughter arteries, while the initial sites of MCA bifurcation aneurysms often overlapped with the shifted high-pressure regions and low wall shear stress regions.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Our results suggest that the initiation of MCA bifurcation aneurysms may correlate with shifts of high-pressure regions and low wall shear stress regions that occur on inclined MCA bifurcations.&lt;/p&gt;" />
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<meta name="twitter:title" content="A Hemodynamic Mechanism Correlating with the Initiation of MCA Bifurcation Aneurysms" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Previous studies have reported that MCA bifurcation aneurysms usually emerge on inclined bifurcations; however, the reason is unclear. We designed this study to explore hemodynamic mechanisms that correlate with the initiation of MCA bifurcation aneurysms.

MATERIALS AND METHODS: Fifty-four patients with unilateral MCA bifurcation aneurysms and 54 control patients were enrolled in this study after propensity score matching, and their clinical and CTA data were collected. We extracted the morphologic features of aneurysmal MCA bifurcations to build a simplified MCA bifurcation model and performed a computational fluid dynamics analysis.

RESULTS: The presence of MCA aneurysms correlated with smaller parent-daughter angles of MCA bifurcations ( P  &lt; .001). Aneurysmal MCA bifurcations usually presented with inclined shapes. The computational fluid dynamics analysis demonstrated that when arterial bifurcations became inclined, the high-pressure regions and low wall shear stress regions shifted from the apexes of the arterial bifurcations to the inclined daughter arteries, while the initial sites of MCA bifurcation aneurysms often overlapped with the shifted high-pressure regions and low wall shear stress regions.

CONCLUSIONS: Our results suggest that the initiation of MCA bifurcation aneurysms may correlate with shifts of high-pressure regions and low wall shear stress regions that occur on inclined MCA bifurcations.

CFD
:   computational fluid dynamics
HPR
:   high-pressure region
LWSS
:   low wall shear stress
LWSSR
:   low wall shear stress region
PSM
:   propensity score matching
RD
:   ratio of diameter
ROC
:   receiver operating characteristic" />
<meta name="og-title" property="og:title" content="A Hemodynamic Mechanism Correlating with the Initiation of MCA Bifurcation Aneurysms" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2020/06/18/ajnr.A6615" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Previous studies have reported that MCA bifurcation aneurysms usually emerge on inclined bifurcations; however, the reason is unclear. We designed this study to explore hemodynamic mechanisms that correlate with the initiation of MCA bifurcation aneurysms.

MATERIALS AND METHODS: Fifty-four patients with unilateral MCA bifurcation aneurysms and 54 control patients were enrolled in this study after propensity score matching, and their clinical and CTA data were collected. We extracted the morphologic features of aneurysmal MCA bifurcations to build a simplified MCA bifurcation model and performed a computational fluid dynamics analysis.

RESULTS: The presence of MCA aneurysms correlated with smaller parent-daughter angles of MCA bifurcations ( P  &lt; .001). Aneurysmal MCA bifurcations usually presented with inclined shapes. The computational fluid dynamics analysis demonstrated that when arterial bifurcations became inclined, the high-pressure regions and low wall shear stress regions shifted from the apexes of the arterial bifurcations to the inclined daughter arteries, while the initial sites of MCA bifurcation aneurysms often overlapped with the shifted high-pressure regions and low wall shear stress regions.

CONCLUSIONS: Our results suggest that the initiation of MCA bifurcation aneurysms may correlate with shifts of high-pressure regions and low wall shear stress regions that occur on inclined MCA bifurcations.

CFD
:   computational fluid dynamics
HPR
:   high-pressure region
LWSS
:   low wall shear stress
LWSSR
:   low wall shear stress region
PSM
:   propensity score matching
RD
:   ratio of diameter
ROC
:   receiver operating characteristic" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node76144--7" data-node-nid="76144" id="top-node-76144--81808263373" data-pisa="ajnr;ajnr.A6615v1" data-pisa-master="ajnr;ajnr.A6615" data-apath="/ajnr/early/2020/06/18/ajnr.A6615.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">INTERVENTIONAL</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">A Hemodynamic Mechanism Correlating with the Initiation of MCA Bifurcation Aneurysms</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Z. Huang</span>, <span class="highwire-citation-author" data-delta="1">M. Zeng</span>, <span class="highwire-citation-author" data-delta="2">W.G. Tao</span>, <span class="highwire-citation-author" data-delta="3">F.Y. Zeng</span>, <span class="highwire-citation-author" data-delta="4">C.Q. Chen</span>, <span class="highwire-citation-author" data-delta="5">L.B. Zhang</span> and <span class="highwire-citation-author" data-delta="6">F.H. Chen</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">June 2020,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6615 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-76144--81808263373" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Z. Huang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurosurgery (Z.H., M.Z., F.H.C., W.G.T.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Z.%2BHuang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Huang%20Z&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AZ.%2BHuang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-0648-3499" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for Z. Huang</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">M. Zeng </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurosurgery (Z.H., M.Z., F.H.C., W.G.T.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BZeng%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zeng%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BZeng%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-8373-4709" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Zeng</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">W.G. Tao </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurosurgery (Z.H., M.Z., F.H.C., W.G.T.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=W.G.%2BTao%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Tao%20W&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AW.G.%2BTao%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-3786-6708" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for W.G. Tao</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">F.Y. Zeng </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>and Radiology (F.Y.Z., C.Q.C.), Xiangya Hospital, Central South University, Changsha, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.Y.%2BZeng%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zeng%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AF.Y.%2BZeng%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-5322-3123" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F.Y. Zeng</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">C.Q. Chen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>and Radiology (F.Y.Z., C.Q.C.), Xiangya Hospital, Central South University, Changsha, China</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.Q.%2BChen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chen%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.Q.%2BChen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8313-6322" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C.Q. Chen</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">L.B. Zhang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Neurosurgery (L.B.Z.), School of Medicine, Yale University, New Haven, Connecticut.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=L.B.%2BZhang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhang%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AL.B.%2BZhang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9077-3239" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for L.B. Zhang</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">F.H. Chen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Departments of Neurosurgery (Z.H., M.Z., F.H.C., W.G.T.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.H.%2BChen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chen%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AF.H.%2BChen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-4462-0880" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F.H. Chen</a></li></ul></div></div></div>  </div>

  
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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">Z. Huang</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-2"><span class="name">M. Zeng</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-3"><span class="name">W.G. Tao</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-4"><span class="name">F.Y. Zeng</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-5"><span class="name">C.Q. Chen</span><a id="xref-aff-2-2" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-6"><span class="name">L.B. Zhang</span><a id="xref-aff-3-1" class="xref-aff" href="#aff-3">c</a> and </li><li class="last" id="contrib-7"><span class="name">F.H. Chen</span><a id="xref-aff-1-4" 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 Departments of Neurosurgery (Z.H., M.Z., F.H.C., W.G.T.)</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>and Radiology (F.Y.Z., C.Q.C.), Xiangya Hospital, Central South University, Changsha, China</address></li><li class="aff"><a id="aff-3" name="aff-3"></a><address><sup>c</sup>Department of Neurosurgery (L.B.Z.), School of Medicine, Yale University, New Haven, Connecticut.</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Fenghua H. Chen, PhD, MD, <span class="addr-line">Department of Neurosurgery, Xiangya Hospital, Central South University, No. 87 Xiangya Rd, Kaifu District, Changsha, 410008, China</span>; e-mail: <span class="em-link"><span class="em-addr">xyswcfh{at}csu.edu.cn</span></span></li></ol></div></div><a href="http://ajnr-stage2.stage.highwire.org/content/early/2020/06/18/ajnr.A6615.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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      <div class="highwire-cite-title">A Hemodynamic Mechanism Correlating with the Initiation of MCA Bifurcation Aneurysms</div>  
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