Is there an inherited anatomical conformation favoring aneurysmal formation of the anterior communicating artery?
OBJECTIVE The pathophysiological mechanisms responsible for the formation of intracranial aneurysms (IAs) remain only partially elucidated. However, current evidence suggests a genetic component. The purpose of this study was to investigate the specific anatomical variations in the arterial complex that are associated with the presence of anterior communicating artery (ACoA) aneurysms in the familial forms of IAs. METHODS This multicenter study investigated bifurcation IAs in patients who had a sporadic ACoA IA without a family history of IA (SACAA group), in patients who had an ACoA IA with a family history of IA (FACAA group), and in their healthy first-degree relatives (HFDRs). Through the use of MR angiography (MRA) reconstructions, the symmetry of the A1segments and the angle between the A1and A2segments were analyzed on 3D models for each group. These measurements were then compared among the 3 groups. RESULTS Twenty-four patients with SACAA, 24 patients with FACAA, and 20 HFDRs were included in the study. Asymmetrical configuration of the A1segments was more frequent in the FACAA group than in the HFDR group (p = 0.002). The aneurysm-side A1-A2angle was lower in the FACAA group (p = 0.003) and SACAA group (p = 0.007) than in the HFDR group. On the contralateral side, there was no difference in A1-A2angles between groups. CONCLUSIONS The anatomical shape of the ACoA complex seems to be similarly associated with the presence of ACoA IAs in both the FACAA and SACAA groups. This highlights the role played by hemodynamic constraints in aneurysm formation and questions the hypothesis of the hereditary character of these anatomical shapes.
Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec.|CNRS, UMR 6291, Université de Nantes, Nantes; and.
Romain
R
Bourcier
Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec.
Cédric
C
Lenoble
INSERM, UMR1087, l'institut du thorax, CHU de Nantes.|CNRS, UMR 6291, Université de Nantes, Nantes; and.
Béatrice
B
Guyomarch-Delasalle
Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec.
Benjamin
B
Daumas-Duport
Department of Diagnostic and Interventional Neuroradiology, CHU Rouen, Rouen, France.
Chrysanthi
C
Papagiannaki
INSERM, UMR1087, l'institut du thorax, CHU de Nantes.|CNRS, UMR 6291, Université de Nantes, Nantes; and.
Richard
R
Redon
Department of Diagnostic and Interventional Neuroradiology, Hospital Guillaume et René Laennec.|CNRS, UMR 6291, Université de Nantes, Nantes; and.
Hubert
H
Desal
D000328:Adult; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged
ACoA = anterior communicating artery; CTA = computed tomography angiography; CW = circle of Willis; FACAA = familial anterior communicating artery aneurysm; FIA = familial intracranial aneurysm; GAIA = genetics of intracranial aneurysm; HFDR = healthy first-degree relative; IA = intracranial aneurysm; MIP = maximum intensity projection; MRA = magnetic resonance angiography; PACS = picture archiving and communication system; SACAA = sporadic anterior communicating artery aneurysm; VAC = vascular asymmetry coefficient; aneurysm; anterior communicating artery; genetics; hemodynamics; vascular disorders