title: Complex hemodynamics at the apex of an arterial bifurcation induces vascular remodeling resembling cerebral aneurysm initiation.
abstract: OBJECTIVE
  Arterial bifurcation apices are common sites for cerebral aneurysms, raising the possibility that the unique hemodynamic conditions associated with flow dividers predispose the apical vessel wall to aneurysm formation. This study sought to identify the specific hemodynamic insults that lead to maladaptive vascular remodeling associated with aneurysm development and to identify early remodeling events at the tissue and cellular levels.
  
  
  METHODS
  We surgically created new branch points in the carotid vasculature of 6 female adult dogs. In vivo angiographic imaging and computational fluid dynamics simulations revealed the detailed hemodynamic microenvironment for each bifurcation, which were then spatially correlated with histologic features showing specific tissue responses.
  
  
  RESULTS
  We observed 2 distinct patterns of vessel wall remodeling: (1) hyperplasia that formed an intimal pad at the bifurcation apex and (2) destructive remodeling in the adjacent region of flow acceleration that resembled the initiation of an intracranial aneurysm, characterized by disruption of the internal elastic lamina, loss of medial smooth muscle cells, reduced proliferation of smooth muscle cells, and loss of fibronectin.
  
  
  CONCLUSIONS
  Strong localization of aneurysm-type remodeling to the region of accelerating flow suggests that a combination of high wall shear stress and a high gradient in wall shear stress represents a "dangerous" hemodynamic condition that predisposes the apical vessel wall to aneurysm formation.
authors.affiliation: Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA. huimeng@buffalo.edu
authors.forename: Hui
authors.initials: H
authors.lastname: Meng
authors.forename: Zhijie
authors.initials: Z
authors.lastname: Wang
authors.forename: Yiemeng
authors.initials: Y
authors.lastname: Hoi
authors.forename: Ling
authors.initials: L
authors.lastname: Gao
authors.forename: Eleni
authors.initials: E
authors.lastname: Metaxa
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Swartz
authors.forename: John
authors.initials: J
authors.lastname: Kolega
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D017536:Carotid Artery, Common / Q000502:physiology*; D002536:Cerebral Arteries / Q000502:physiology; D004285:Dogs; D005260:Female; D002532:Intracranial Aneurysm / Q000209:etiology* / Q000503:physiopathology*