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Original research
Bifurcation geometry remodelling of vessels in de novo and growing intracranial aneurysms: a multicenter study
  1. Julien Boucherit1,
  2. Basile Kerleroux2,
  3. Gregoire Boulouis3,
  4. Guillaume Tessier4,
  5. Christine Rodriguez5,
  6. Peter B Sporns6,
  7. Haroun Ghannouchi7,
  8. Eimad Shotar8,
  9. Florent Gariel9,
  10. Gaultier Marnat10,
  11. Julien Burel11,
  12. Heloise Ifergan12,
  13. Géraud Forestier13,
  14. Aymeric Rouchaud14,15,
  15. Hubert Desal16,
  16. Anass Nouri17,18,
  17. Florent Autrusseau19,
  18. Gervaise Loirand20,
  19. Romain Bourcier21,
  20. Vincent L'Allinec22
  21. JENI Research Collaborative
    1. 1 Radiology, University Hospital Center Angers, Angers, France
    2. 2 Radiology, Saint Anne Hospital Center, Paris, France
    3. 3 Neuroradiology Department, CHRU Tours, Tours, France
    4. 4 Neuroradiology Department, CHU Nantes, Nantes, France
    5. 5 Neuroradiology, Hospital Saint Anne, Paris, France
    6. 6 Department of Neuroradiology, University Hospital Basel, Basel, Switzerland
    7. 7 Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
    8. 8 Neuroradiology, Pitié-Salpêtrière Hospital, APHP, Paris, France
    9. 9 Interventional Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, France
    10. 10 Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
    11. 11 Service de Radiologie, CHU Rouen, Rouen, France
    12. 12 Diagnostic and Interventional Neuroradiology, CHU Tours, Tours, France
    13. 13 Centre Hospitalier Universitaire de Limoges, Limoges, France
    14. 14 Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
    15. 15 Univ Limoges, CNRS, XLIM, UMR 7252, Limoges, France
    16. 16 Neuroradiology, University Hospital of Nantes, Nantes, France
    17. 17 ESC Nantes, Nantes, France
    18. 18 Laboratoire des Systèmes Électroniques, Traitement de l’Information, Mécanique et Énergétique, Ibn Tofail University, Kenitra, Morocco
    19. 19 LTeN UMR-6607, Polytech Nantes School of Engineering, Nantes, France
    20. 20 Inserm U533, Université de Nantes, Nantes, France
    21. 21 Neuroradiology, Université de Nantes, Nantes, France
    22. 22 Service de Neuroradiologie Diagnostique et Interventionnelle, Centre Hospitalier Universitaire de Nantes, Nantes, France
    1. Correspondence to Dr Julien Boucherit, Radiology, Centre Hospitalier Universitaire d'Angers, Service de Neuroradiologie Interventionnelle 4 rue Larrey 49100, Angers, France; julien.boucherit{at}


    Background Geometrical parameters, including arterial bifurcation angle, tortuosity, and arterial diameters, have been associated with the pathophysiology of intracranial aneurysm (IA) formation. The aim of this study was to investigate whether these parameters were present before or if they resulted from IA formation and growth.

    Methods Patients from nine academic centers were retrospectively identified if they presented with a de novo IA or a significant IA growth on subsequent imaging. For each patient, geometrical parameters were extracted using a semi-automated algorithm and compared between bifurcations with IA formation or growth (aneurysmal group), and their contralateral side without IA (control group). These parameters were compared at two different times using univariable models, multivariable models, and a sensitivity analysis with paired comparison.

    Results 46 patients were included with 21 de novo IAs (46%) and 25 significant IA growths (54%). The initial angle was not different between the aneurysmal and control groups (129.7±42.1 vs 119.8±34.3; p=0.264) but was significantly wider at the final stage (140.4±40.9 vs 121.5±34.1; p=0.032), with a more important widening of the aneurysmal angle (10.8±15.8 vs 1.78±7.38; p=0.001). Variations in other parameters were not significant. These results were confirmed by paired comparisons.

    Conclusion Our study suggests that wider bifurcation angles that have long been deemed causal factors for IA formation or growth may be secondary to IA formation at pathologic bifurcation sites. This finding has implications for our understanding of IA formation pathophysiology.

    • Aneurysm
    • History
    • Inflammatory Response
    • Technology

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    • Twitter @BoucheritJulien, @gboulouis, @vlallinec

    • Collaborators Pasco-Papon Anne, Girot Jean-Baptiste, Tanguy Jean-Yves, Labriffe Matthieu (University Hospital of Angers), Mounayer Charbel, Saleme Suzana (University Hospital of Limoges), Berge Jérôme, Barreau Xavier, Menegon Patrice, Tourdias Thomas (University Hospital of Bordeaux), Detraz Lili, Lenoble Cédric, Alexandre Pierre-Louis, Daumas-Duport Benjamin (University Hospital of Nantes), Clarençon Frédéric, Sourour Nader-Antoine, Lenck Stéphanie, Premat Kevin (University Hospital of Pitié Salpétrière), Papagiannaki Chrysanthi, Curado Adelya, Lefebvre Margaux, Le Moal Julien, Gerardin Emmanuel (University Hospital of Rouen), Naggara Olivier, Trystram Denis, Ben Hassen Wagih (University Hospital of Saint-Anne), Psychogios Marios (University Hospital of Basel), Janot Kevin, Planty-Bonjour Alexia (University Hospital of Tours).

    • Contributors JBo: collected the data, performed the computational analysis, wrote the manuscript and acted as guarantor. BK: collected the data, performed the statistical analysis, and critically reviewed the manuscript. GT, RB, CR, PBS, HG, ES, FG, GM, JBu, HI, GB, GF, AR, and HD: collected the data and critically reviewed the manuscript. AN and FA: developed the algorithm and critically reviewed the manuscript. GL: critically reviewed the manuscript. VL: had the concept of the study, collected the data, and wrote and critically reviewed the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.