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.
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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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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.
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