{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T09:46:28Z","timestamp":1788515188209,"version":"build-2803163510"},"reference-count":30,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2020,4,25]]},"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Aneurysms at the posterior communicating artery (PCOM) origin represent the most common location on the internal carotid artery (ICA), and are associated with greater recurrence following endovascular treatment. We evaluate the association between ICA angulation in three-dimensional (3D) space and PCOM aneurysmal development, using high-resolution 3D rotational angiography (3DRA) studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>3DRA datasets were evaluated in 70 patients with PCOM aneurysms, 31 non-aneurysmal contralateral, and 86 healthy controls (187 total). The local angle formed by upstream and downstream ICA segments at the PCOM origin, \u03b1<jats:sub>ICA@PCOM<\/jats:sub>, was measured using 3DRA multiplanar reconstruction. Computational fluid dynamics (CFD) analysis was performed on parametric and patient-based models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>\u03b1<jats:sub>ICA@PCOM<\/jats:sub>was significantly larger in aneurysm-bearing ICA segments (68.14\u00b111.91\u00b0) compared with non-aneurysmal contralateral (57.17\u00b110.76\u00b0, p&lt;0.001) and healthy controls (48.13\u00b113.68\u00b0, p&lt;0.001). A discriminant threshold \u03b1<jats:sub>ICA@PCOM<\/jats:sub>value of 61\u00b0 (87% specificity, 80% sensitivity) was established (area under the curve (AUC)=0.88). Ruptured PCOM aneurysms had a significantly larger \u03b1<jats:sub>ICA@PCOM<\/jats:sub>compared to unruptured (72.65\u00b115.16\u00b0 vs 66.35\u00b19.94\u00b0, p=0.04). In parametric and patient-based CFD analysis, a large \u03b1<jats:sub>ICA@PCOM<\/jats:sub>induces high focal pressure at the PCOM origin, relatively low wall shear stress (WSS), and high proximal WSS spatial gradients (WSSG).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ICA angulation at PCOM origin is significantly higher in vessels harboring PCOM aneurysms compared with contralateral and healthy ICAs. This sharper bend in the ICA leads to high focal pressure at the aneurysm neck, low focal WSS and high proximal WSSG. These findings underline the importance of morphological ICA variations and the likelihood of PCOM aneurysm, an association which can inform clinical decisions and may serve in predictive analytics.<\/jats:p><\/jats:sec>","DOI":"10.1136\/neurintsurg-2020-015883","type":"journal-article","created":{"date-parts":[[2020,5,23]],"date-time":"2020-05-23T21:19:40Z","timestamp":1590268780000},"page":"1142-1147","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Increased focal internal carotid artery angulation in patients with posterior communicating artery aneurysms"],"prefix":"10.1136","volume":"12","author":[{"given":"Richard","family":"Rosato","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Comptdaer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Mulligan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M","family":"Breton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emal","family":"Lesha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Lauric","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adel M","family":"Malek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,5,23]]},"reference":[{"key":"2024052305492060000_12.11.1142.1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.fluid.40.111406.102126"},{"key":"2024052305492060000_12.11.1142.2","doi-asserted-by":"crossref","DOI":"10.4103\/2152-7806.74147","article-title":"A review of the management of posterior communicating artery aneurysms in the modern era","volume":"1","author":"Golshani","year":"2010","journal-title":"Surg Neurol Int"},{"key":"2024052305492060000_12.11.1142.3","doi-asserted-by":"publisher","DOI":"10.3171\/2011.11.JNS11311"},{"key":"2024052305492060000_12.11.1142.4","doi-asserted-by":"publisher","DOI":"10.4103\/2152-7806.74147"},{"key":"2024052305492060000_12.11.1142.5","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.005393"},{"key":"2024052305492060000_12.11.1142.6","doi-asserted-by":"publisher","DOI":"10.3171\/2014.8.JNS1447"},{"key":"2024052305492060000_12.11.1142.7","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2013-010987"},{"key":"2024052305492060000_12.11.1142.8","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e31820b5242"},{"key":"2024052305492060000_12.11.1142.9","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.24.7.1029"},{"key":"2024052305492060000_12.11.1142.10","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2004.101.1.0108"},{"key":"2024052305492060000_12.11.1142.11","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1016\/j.jocn.2010.03.035","article-title":"Morphological differences between the aneurysmal and normal artery in patients with internal carotid-posterior communicating artery aneurysm","volume":"17","author":"Yu","year":"2010","journal-title":"J Clin Neurosci"},{"key":"2024052305492060000_12.11.1142.12","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1080\/01616412.2016.1238662","article-title":"Association between anatomical variations of the posterior communicating artery and the presence of aneurysms","volume":"38","author":"Hu","year":"2016","journal-title":"Neurol Res"},{"key":"2024052305492060000_12.11.1142.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcm.2016.02.012"},{"key":"2024052305492060000_12.11.1142.14","doi-asserted-by":"crossref","first-page":"3018","DOI":"10.1016\/j.jbiomech.2014.06.042","article-title":"Curvature effect on hemodynamic conditions at the inner bend of the carotid siphon and its relation to aneurysm formation","volume":"47","author":"Lauric","year":"2014","journal-title":"J Biomech"},{"key":"2024052305492060000_12.11.1142.15","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000298915.32248.95"},{"key":"2024052305492060000_12.11.1142.16","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-013-0450-5"},{"key":"2024052305492060000_12.11.1142.17","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.jns.2017.01.062","article-title":"Relationship of the angle between the A1 and A2 segments of the anterior cerebral artery with formation and rupture of anterior communicating artery aneurysm","volume":"375","author":"Ye","year":"2017","journal-title":"J Neurol Sci"},{"key":"2024052305492060000_12.11.1142.18","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.570770"},{"key":"2024052305492060000_12.11.1142.19","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e3182846d9f"},{"key":"2024052305492060000_12.11.1142.20","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A2841"},{"key":"2024052305492060000_12.11.1142.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2013.11.028"},{"key":"2024052305492060000_12.11.1142.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiomed.2014.07.006"},{"key":"2024052305492060000_12.11.1142.23","doi-asserted-by":"crossref","first-page":"634","DOI":"10.3349\/ymj.2007.48.4.634","article-title":"Association between internal carotid artery morphometry and posterior communicating artery aneurysm","volume":"48","author":"Kim","year":"2007","journal-title":"Yonsei Med J"},{"key":"2024052305492060000_12.11.1142.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2015.05.078"},{"key":"2024052305492060000_12.11.1142.25","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-012-0695-0"},{"key":"2024052305492060000_12.11.1142.26","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-011-0267-8"},{"key":"2024052305492060000_12.11.1142.27","doi-asserted-by":"publisher","DOI":"10.3171\/2013.2.JNS12968"},{"key":"2024052305492060000_12.11.1142.28","doi-asserted-by":"crossref","first-page":"442","DOI":"10.3171\/2018.3.JNS173128","article-title":"Induction of aneurysmogenic high positive wall shear stress gradient by wide angle at cerebral bifurcations, independent of flow rate","volume":"131","author":"Lauric","year":"2018","journal-title":"J Neurosurg"},{"key":"2024052305492060000_12.11.1142.29","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A2584"},{"key":"2024052305492060000_12.11.1142.30","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A3062"}],"container-title":["Journal of NeuroInterventional Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/neurintsurg-2020-015883","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T12:49:33Z","timestamp":1716468573000},"score":1,"resource":{"primary":{"URL":"https:\/\/jnis.bmj.com\/lookup\/doi\/10.1136\/neurintsurg-2020-015883"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,23]]},"references-count":30,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,10,15]]},"published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1136\/neurintsurg-2020-015883"],"URL":"https:\/\/doi.org\/10.1136\/neurintsurg-2020-015883","relation":{},"ISSN":["1759-8478","1759-8486"],"issn-type":[{"value":"1759-8478","type":"print"},{"value":"1759-8486","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,23]]}}}