Anatomy and Cell Biology

  • 제56권3호
  • /
  • Pages.360-366
  • /
  • 2023
  • /
  • 2093-3665(pISSN)
  • /
  • 2093-3673(eISSN)
대한해부학회 (Korean Association of Anatomists)
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Morphology of middle cerebral artery using computed tomography angiographic study in a tertiary care hospital

  • Urvi Sharma (Department of Anatomy, All India Institute of Medical Sciences) ;
  • Suman Verma (Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research) ;
  • Subathra Adithan (Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research)
  • 투고 : 2022.11.26
  • 심사 : 2023.04.27
  • 발행 : 2023.09.30
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초록

Increased tortuosity of vessel is associated with high incidence of plaque formation leading to atherosclerosis. Surgical procedures are done after analyzing morphology of middle cerebral artery (MCA). However, literature describing MCA morphology using computed tomography angiography (CTA) is limited, so this study was planned to determine its incidence in Indian population. Datasets of CTA from 289 patients (180 males and 109 females), average age: 49.29±16.16 years (range: 11 to 85 years), from a tertiary care hospital were systematically reviewed for morphology of MCA. Cases involving aneurysms and infarcts were excluded. Four shapes of MCA were recognized: straight, U, inverted U, and S-shaped. MCA was straight in 44% (254/578), U-shaped in 37% (215/578), S shaped in 15% (89/578) and inverted U-shaped in 3% (20/578) cases. In males, MCA was straight in 46% (166/360), U-shaped in 37% (134/360), S-shaped in 16% (58/360) and inverted U-shaped in 4% (14/360) cases. In females, MCA was straight in 42% cases (92/218), U-shaped in 37% (81/218), S-shaped in 17% (36/218) and inverted U-shaped in 4% (9/218). On comparing shape with various age groups using chi square test, U shaped (P≤0.001) and S-shaped (P=0.003) MCA were found to be statistically significant. The incidence of straight shape was higher in advanced age group (>60 years). Knowledge of MCA shape will be useful for clinicians and surgeons in successful endovascular recanalization. Also, this data would help surgeons during neurointerventional procedures.

키워드

과제정보

I would like to express my sincere gratitude to the head of department of anatomy and radiology, JIPMER for encouraging me to conduct this study.

참고문헌

  1. Shalom DE, Trevisan MA, Mallela A, Nunez M, Goldschmidt E. Brain folding shapes the branching pattern of the middle cerebral artery. PLoS One 2021;16:e0245167. 
  2. Han J, Qiao H, Li X, Li X, He Q, Wang Y, Cheng Z. The three-dimensional shape analysis of the M1 segment of the middle cerebral artery using MRA at 3T. Neuroradiology 2014;56:995-1005. 
  3. Mazighi M, Tanasescu R, Ducrocq X, Vicaut E, Bracard S, Houdart E, Woimant F. Prospective study of symptomatic atherothrombotic intracranial stenoses: the GESICA study. Neurology 2006;66:1187-91. 
  4. Sanchez-Sanchez C, Egido JA, Gonzalez-Gutierrez JL, MeraCampillo J, Carneado-Ruiz J, Diaz-Otero F. [Stroke and intracranial stenosis: clinical profile in a series of 134 patients in Spain]. Rev Neurol 2004;39:305-11. Spanish. 
  5. Malek AM, Alper SL, Izumo S. Hemodynamic shear stress and its role in atherosclerosis. JAMA 1999;282:2035-42. 
  6. Fuster V, Badimon JJ, Chesebro JH. Atherothrombosis: mechanisms and clinical therapeutic approaches. Vasc Med 1998;3:231-9. 
  7. Zhang C, Xie S, Li S, Pu F, Deng X, Fan Y, Li D. Flow patterns and wall shear stress distribution in human internal carotid arteries: the geometric effect on the risk for stenoses. J Biomech 2012;45:83-9. 
  8. Datir P, Lee AY, Lamm SD, Han HC. Effects of geometric variations on the buckling of arteries. Int J Appl Mech 2011;3:385-406. 
  9. Smedby O, Johansson J, Molgaard J, Olsson AG, Walldius G, Erikson U. Predilection of atherosclerosis for the inner curvature in the femoral artery. A digitized angiography study. Arterioscler Thromb Vasc Biol 1995;15:912-7. 
  10. Kim BJ, Yoon Y, Lee DH, Kang DW, Kwon SU, Kim JS. The shape of middle cerebral artery and plaque location: high-resolution MRI finding. Int J Stroke 2015;10:856-60. 
  11. Reci V, Bexheti S. Morphologic variations of end trunks of M1 segment of middle cerebral artery. J Alzheimers Neurodegener Dis 2019;5:030. 
  12. Yu YN, Li ML, Xu YY, Meng Y, Trieu H, Villablanca JP, Gao S, Feng F, Liebeskind DS, Xu WH. Middle cerebral artery geometric features are associated with plaque distribution and stroke. Neurology 2018;91:e1760-9. 
  13. Xu WH, Li ML, Gao S, Ni J, Zhou LX, Yao M, Peng B, Feng F, Jin ZY, Cui LY. Plaque distribution of stenotic middle cerebral artery and its clinical relevance. Stroke 2011;42:2957-9. 
  14. Kiresi D, Gumus S, Cengiz SL, Cicekcibasi A. The morphometric analysis of the V2 and V3 segments of the vertebral artery: normal values on MDCT. Comput Med Imaging Graph 2009;33:399-407. 
  15. Jeyakumar R, Veerapandian R. Study of anatomical variations in middle cerebral artery. Int J Sci Study 2018;5:5-10. 
  16. Gibo H, Carver CC, Rhoton AL Jr, Lenkey C, Mitchell RJ. Microsurgical anatomy of the middle cerebral artery. J Neurosurg 1981;54:151-69. 
  17. Herman LH, Ostrowski AZ, Gurdjian ES. Perforating branches of the middle cerebral artery. An anatomical study. Arch Neurol 1963;8:32-4. 
  18. Vuillier F, Medeiros E, Moulin T, Cattin F, Bonneville JF, Tatu L. Main anatomical features of the M1 segment of the middle cerebral artery: a 3D time-of-flight magnetic resonance angiography at 3 T study. Surg Radiol Anat 2008;30:509-14. 
  19. Lazorthes G, Gouaze A, Salamon G. Vascularisation et circulation de l'encephale. Les veines de l'encephale. Masson; 1976. 
  20. Rosner SS, Rhoton AL Jr, Ono M, Barry M. Microsurgical anatomy of the anterior perforating arteries. J Neurosurg 1984;61:468-85. 
  21. Nomura T. Atlas of cerebral angiography. Springer; 1970. 
  22. Benetos A, Waeber B, Izzo J, Mitchell G, Resnick L, Asmar R, Safar M. Influence of age, risk factors, and cardiovascular and renal disease on arterial stiffness: clinical applications. Am J Hypertens 2002;15:1101-8. 
  23. Stone PH, Coskun AU, Kinlay S, Clark ME, Sonka M, Wahle A, Ilegbusi OJ, Yeghiazarians Y, Popma JJ, Orav J, Kuntz RE, Feldman CL. Effect of endothelial shear stress on the progression of coronary artery disease, vascular remodeling, and in-stent restenosis in humans: in vivo 6-month follow-up study. Circulation 2003;108:438-44. 
  24. Asakura T, Karino T. Flow patterns and spatial distribution of atherosclerotic lesions in human coronary arteries. Circ Res 1990;66:1045-66. 
  25. Chistiakov DA, Orekhov AN, Bobryshev YV. Effects of shear stress on endothelial cells: go with the flow. Acta Physiol (Oxf) 2017;219:382-408. 
  26. Dolan JM, Kolega J, Meng H. High wall shear stress and spatial gradients in vascular pathology: a review. Ann Biomed Eng 2013;41:1411-27. 
  27. Schwaiger BJ, Gersing AS, Zimmer C, Prothmann S. The curved MCA: influence of vessel anatomy on recanalization results of mechanical thrombectomy after acute ischemic stroke. AJNR Am J Neuroradiol 2015;36:971-6. 
  28. Mori T, Fukuoka M, Kazita K, Mori K. Follow-up study after intracranial percutaneous transluminal cerebral balloon angioplasty. AJNR Am J Neuroradiol 1998;19:1525-33. 
  29. Zhu L, Liebeskind DS, Jahan R, Starkman S, Salamon N, Duckwiler G, Vinuela F, Tateshima S, Gonzalez N, Villablanca P, Ali LK, Kim D, Ovbiagele B, Froehler M, Tenser M, Saver JL. Thrombus branching and vessel curvature are important determinants of middle cerebral artery trunk recanalization with Merci thrombectomy devices. Stroke 2012;43:787-92. 
  30. Patti G, Pasceri V, Melfi R, Goffredo C, Chello M, D'Ambrosio A, Montesanti R, Di Sciascio G. Impaired flow-mediated dilation and risk of restenosis in patients undergoing coronary stent implantation. Circulation 2005;111:70-5. 
  31. Papafaklis MI, Chatzizisis YS, Naka KK, Giannoglou GD, Michalis LK. Drug-eluting stent restenosis: effect of drug type, release kinetics, hemodynamics and coating strategy. Pharmacol Ther 2012;134:43-53. 
  32. Santamarina A, Weydahl E, Siegel JM Jr, Moore JE Jr. Computational analysis of flow in a curved tube model of the coronary arteries: effects of time-varying curvature. Ann Biomed Eng 1998;26:944-54. 
  33. Hademenos GJ, Massoud TF. Biophysical mechanisms of stroke. Stroke 1997;28:2067-77. 
  34. Klis KM, Krzyzewski RM, Kwinta BM, Lasocha B, Brzegowy P, Stachura K, Popiela TJ, Borek R, Gasowski J. Increased tortuosity of basilar artery might be associated with higher risk of aneurysm development. Eur Radiol 2020;30:5625-32. 
  35. National Institute of Neurological Disorders and Stroke. Cerebral arteriosclerosis [Internet]. National Institutes of Health; 1950 [cited 2023 Jan 23]. Available from: https://www.ninds.nih.gov/health-information/disorders/cerebral-arteriosclerosis