Sex differences in intracranial arterial bifurcations |
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| Authors: | Haakon M. Lindekleiv Kristian Valen-Sendstad Michael K. Morgan Kent-Andre Mardal Kenneth Faulder Jeanette H. Magnus Knut Waterloo Bertil Romner Tor Ingebrigtsen |
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| Affiliation: | 1. Department of Clinical Medicine, University of Tromsø, Tromsø, Norway;2. Department of Neurosurgery, University Hospital of North Norway, Tromsø, Norway;3. Simula Research Laboratory, Oslo, Norway;4. Australian School of Advanced Medicine, Macquarie University, Sydney, Australia;5. Department of Radiology, Dalcross Private Hospital, Sydney, Australia;6. Tulane Xavier National Center of Excellence in Women''s Health, Tulane University, New Orleans, Louisiana;1. Department of Obstetrics and Gynecology, Rowan University – School of Osteopathic Medicine, Stratford, NJ, United States;2. Department of Obstetrics and Gynecology, Yale University – School of Medicine, OB/GYN, New Haven, CT, United States;3. Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States;1. Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;2. Department of Administration, Oklahoma University Medical Center, Oklahoma City, Oklahoma;3. Department of Surgery, University of Toronto, Toronto, Ontario, Canada;1. Service de neurologie, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France;2. Urgences cérébrovasculaires, groupe hospitalier Pité-Salpêtrière, Assistance publique–Hôpitaux de Paris (AP–HP), 47-83, boulevard de l’Hôpital, 75013 Paris, France;3. Brigade des sapeurs-pompiers de Paris, caserne de Port-Royal, 75013 Paris, France;4. SAMU de Paris, hôpital Necker–Enfants-Malades, université Paris Descartes – Paris V, AP–HP, 75730 Paris cedex 15, France;5. GCS DSISIF, 75009 Paris, France;1. Department of Emergency “Policlinico Umberto I,” “Sapienza” University of Rome, Rome Italy;2. Department of Vascular Surgery A, “Policlinico Umberto I,” “Sapienza” University of Rome, Rome Italy |
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| Abstract: | Background: Subarachnoid hemorrhage (SAH) is a serious condition, occurring more frequently in females than in males. SAH is mainly caused by rupture of an intracranial aneurysm, which is formed by localized dilation of the intracranial arterial vessel wall, usually at the apex of the arterial bifurcation. The female preponderance is usually explained by systemic factors (hormonal influences and intrinsic wall weakness); however, the uneven sex distribution of intracranial aneurysms suggests a possible physiologic factor—a local sex difference in the intracranial arteries.Objective: The aim of this study was to explore sex variation in the bifurcation anatomy of the middle cerebral artery (MCA) and internal carotid artery (ICA), and the subsequent hemodynamic impact.Methods: Vessel radii and bifurcation angles were measured in patients with MCA and ICA bifurcations. Data from a previously published study of 55 patients undergoing diagnostic cerebral digital subtraction angiography at Dalcross Private Hospital in Sydney, Australia, between 2002 and 2003, were available for analysis. The measurements were used to create idealized, averaged bifurcations of the MCA and ICA for females and males. Computational fluid dynamics simulations were performed to calculate hemodynamic forces in the models.Results: The vessel radii and bifurcation angles of 47 MCA and 52 ICA bifurcations in 49 patients (32 females, 17 males; mean age, 53 years; age range, 14–86 years) were measured. Statistically significant sex differences were found in vessel diameter (males larger than females; P < 0.05), but not in bifurcation angle. Computational fluid dynamics simulations revealed higher wall shear stress in the female MCA (19%) and ICA (50%) bifurcations compared with the male bifurcations.Conclusions: This study of MCA and ICA bifurcations in female and male patients suggests that sex differences in vessel size and blood flow velocity result in higher hemodynamic forces acting on the vessel wall in females. This new hypothesis may partly explain why intracranial aneurysms and SAH are more likely to occur in females than in males. |
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