{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:24:42Z","timestamp":1785731082496,"version":"3.56.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T00:00:00Z","timestamp":1697068800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To retrospectively investigate the hemodynamic stresses in initiating aneurysm formation on major cerebral arterial bifurcations with computational fluid dynamics (CFD) analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The cerebral 3D angiographic data of major cerebral arterial bifurcations of the internal carotid, middle cerebral, anterior cerebral, and basilar arteries in 80 patients harboring bifurcation aneurysms and 80 control subjects with no aneurysms were retrospectively collected for the CFD analysis of hemodynamic stresses associated with aneurysm formation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Bifurcation angles at major bifurcations in all patients were significantly positively (<jats:italic>P<\/jats:italic> &amp;lt; 0.001) correlated with the age. At the center of direct flow impingement (CDFI) on the bifurcation wall, total pressure was the highest but dropped rapidly toward the branches. Wall shear stress, dynamic pressure, strain rate, and vorticity were lowest at the CDFI but they increased quickly toward the branches. The bifurcation angle was significantly (<jats:italic>P<\/jats:italic> &amp;lt; 0.001) enlarged in patients with bifurcation aneurysms than those without them, for all major arterial bifurcations. Most aneurysms leaned toward the smaller arterial branch or the arterial branch that formed a smaller angle with the parent artery, where the hemodynamic stresses increased significantly (<jats:italic>P<\/jats:italic> &amp;lt; 0.05), compared with those on the contralateral arterial branch forming a larger angle with the parent artery. Following the aneurysm development, all the hemodynamic stresses on the aneurysm dome decreased significantly (<jats:italic>P<\/jats:italic> &amp;lt; 0.001) compared with those at the initiation site on the bifurcation wall after virtual aneurysm removal. With the decrease of bifurcation angles, all the hemodynamic stresses decreased.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The formation of intracranial aneurysms on major intracranial arterial bifurcations is significantly associated with locally abnormally augmented hemodynamic stresses, which must be reduced.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2023.1265484","type":"journal-article","created":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T09:50:53Z","timestamp":1697104253000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Greater hemodynamic stresses initiate aneurysms on major cerebral arterial bifurcations"],"prefix":"10.3389","volume":"14","author":[{"given":"Hao","family":"Guo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian-Feng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cong-Hui","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji-Wei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bu-Lang","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,10,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.3171\/2009.10.JNS09759","article-title":"The critical role of hemodynamics in the development of cerebral vascular disease","volume":"112","author":"Nixon","year":"2010","journal-title":"J Neurosurg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"823","DOI":"10.3171\/jns.1989.70.6.0823","article-title":"Etiology of intracranial berry aneurysms","volume":"70","author":"Stehbens","year":"1989","journal-title":"J Neurosurg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"64","DOI":"10.3171\/jns.2002.96.1.0064","article-title":"Sizes of ruptured and unruptured aneurysms in relation to their sites and the ages of patients","volume":"96","author":"Weir","year":"2002","journal-title":"J Neurosurg."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1924","DOI":"10.1161\/STROKEAHA.106.481234","article-title":"Complex hemodynamics at the apex of an arterial bifurcation induces vascular remodeling resembling cerebral aneurysm initiation","volume":"38","author":"Meng","year":"2007","journal-title":"Stroke."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3171\/2010.9.JNS10368","article-title":"Progressive aneurysm development following hemodynamic insult","author":"Meng","year":"2010","journal-title":"J Neurosurg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1774","DOI":"10.1161\/STROKEAHA.110.585992","article-title":"Characterization of critical hemodynamics contributing to aneurysmal remodeling at the basilar terminus in a rabbit model","volume":"41","author":"Metaxa","year":"2010","journal-title":"Stroke."},{"key":"B7","doi-asserted-by":"publisher","first-page":"666","DOI":"10.3171\/jns.1972.37.6.0666","article-title":"Physical factors in the initiation, growth, and rupture of human intracranial saccular aneurysms","volume":"37","author":"Ferguson","year":"1972","journal-title":"J Neurosurg."},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.27.11.2086","article-title":"Hemodynamic study of the anterior communicating artery","author":"Ujiie","year":"1996","journal-title":"Stroke"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.surneu.2008.12.013","article-title":"Patient-specific hemodynamic analysis of small internal carotid artery-ophthalmic artery aneurysms","author":"Chien","year":"2009","journal-title":"Surg Neurol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e3182846d9f","article-title":"Y-stent coiling of basilar bifurcation aneurysms induces a dynamic angular vascular remodeling with alteration of the apical wall shear stress pattern","author":"Gao","year":"2013","journal-title":"Neurosurgery"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e3181f9a93b","article-title":"Critical influence of framing coil orientation on intra-aneurysmal and neck region hemodynamics in a sidewall aneurysm model","author":"Schirmer","year":"2010","journal-title":"Neurosurgery"},{"key":"B12","doi-asserted-by":"publisher","first-page":"108","DOI":"10.3171\/jns.2004.101.1.0108","article-title":"Bifurcation geometry and the presence of cerebral artery aneurysms","volume":"101","author":"Ingebrigtsen","year":"2004","journal-title":"J Neurosurg."},{"key":"B13","first-page":"1113","article-title":"Hemodynamics in a cerebral artery before and after the formation of an aneurysm","volume":"27","author":"Mantha A1","year":"2006","journal-title":"Am J Neuroradiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1016\/j.jocn.2012.12.003","article-title":"A combination of genetic, molecular and haemodynamic risk factors contributes to the formation, enlargement and rupture of brain aneurysms","volume":"20","author":"Francis","year":"2013","journal-title":"J Clin Neurosci."},{"key":"B15","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1161\/01.STR.16.3.377","article-title":"Risk factors for subarachnoid hemorrhage","volume":"16","author":"Longstreth","year":"1985","journal-title":"Stroke."},{"key":"B16","doi-asserted-by":"publisher","first-page":"3613","DOI":"10.1161\/STROKEAHA.113.002390","article-title":"Review of cerebral aneurysm formation, growth, and rupture","volume":"44","author":"Chalouhi","year":"2013","journal-title":"Stroke."},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1227\/00006123-199907000-00021","article-title":"Angles between a1 and a2 segments of the anterior cerebral artery visualized by three-dimensional computed tomographic angiography and association of anterior communicating artery aneurysms","author":"Kasuya","year":"1999","journal-title":"Neurosurgery"},{"key":"B18","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1088\/0967-3334\/26\/4\/013","article-title":"Characterization of volumetric flow rate waveforms in the normal internal carotid and vertebral arteries","volume":"26","author":"Ford","year":"2005","journal-title":"Physiol Meas."},{"key":"B19","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1016\/0021-9150(81)90027-7","article-title":"Correlation between intimal thickness and fluid shear in human arteries","volume":"39","author":"Friedman","year":"1981","journal-title":"Atherosclerosis."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1681","DOI":"10.1007\/s10439-008-9540-x","article-title":"Endothelial cell layer subjected to impinging flow mimicking the apex of an arterial bifurcation","volume":"36","author":"Szymanski","year":"2008","journal-title":"Ann Biomed Eng."},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.surneu.2009.03.030","article-title":"Flow patterns and distributions of fluid velocity and wall shear stress in the human internal carotid and middle cerebral arteries","author":"Takeuchi","year":"2010","journal-title":"World Neurosurg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1161\/01.STR.3.3.255","article-title":"The hemodynamic importance of the geometry of bifurcations in the circle of willis (glass model studies)","volume":"3","author":"Roach","year":"1972","journal-title":"Stroke."},{"key":"B23","doi-asserted-by":"publisher","first-page":"H1209","DOI":"10.1152\/ajpheart.01047.2006","article-title":"Mechanotransduction and endothelial cell homeostasis: the wisdom of the cell","volume":"292","author":"Chien","year":"2007","journal-title":"Am J Physiol Heart Circ Physiol."},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000245599.92322.53","article-title":"A model system for mapping vascular responses to complex hemodynamics at arterial bifurcations in vivo","author":"Meng","year":"2006","journal-title":"Neurosurgery"},{"key":"B25","doi-asserted-by":"publisher","first-page":"6","DOI":"10.4103\/abr.abr_77_15","article-title":"Epidemiologic and demographic features, therapeutic intervention and prognosis of the patients with cerebral aneurysm","volume":"7","author":"Sabouri","year":"2018","journal-title":"Adv Biomed Res."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.3171\/2014.8.JNS1447","article-title":"Widening of the basilar bifurcation angle: association with presence of intracranial aneurysm, age, and female sex","volume":"121","author":"Tutuncu","year":"2014","journal-title":"J Neurosurg."},{"key":"B27","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1161\/STROKEAHA.117.019701","article-title":"Presence of anterior communicating artery aneurysm is associated with age, bifurcation angle, and vessel diameter","volume":"49","author":"Zhang","year":"2018","journal-title":"Stroke."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1161\/01.STR.0000124926.76836.df","article-title":"Morphometry of medial gaps of human brain artery branches","volume":"35","author":"Canham","year":"2004","journal-title":"Stroke."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1595","DOI":"10.1161\/01.STR.29.8.1595","article-title":"Collagen organization in the branching region of human brain arteries","volume":"29","author":"Finlay","year":"1998","journal-title":"Stroke."},{"key":"B30","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1159\/000072831","article-title":"Collagen biomechanics in cerebral arteries and bifurcations assessed by polarizing microscopy","volume":"40","author":"Rowe","year":"2003","journal-title":"J Vasc Res."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.08.167","article-title":"Enlarged anterior cerebral artery bifurcation angles may induce abnormally enhanced hemodynamic stresses to initiate aneurysms","author":"Zhang","year":"2018","journal-title":"World Neurosurg"},{"key":"B32","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.jocn.2021.12.005","article-title":"Greater hemodynamic stresses initiated the anterior communicating artery aneurysm on the vascular bifurcation apex","volume":"96","author":"Gao","year":"2022","journal-title":"J Clin Neurosci."},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e318286fab3","article-title":"Angular remodeling in single stent-assisted coiling displaces and attenuates the flow impingement zone at the neck of intracranial bifurcation aneurysms","author":"Gao","year":"2013","journal-title":"Neurosurgery"},{"key":"B34","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1002\/jmri.23501","article-title":"High resolution three-dimensional cine phase contrast mri of small intracranial aneurysms using a stack of stars k-space trajectory","volume":"35","author":"Kecskemeti S1","year":"2012","journal-title":"J Magn Reson Imaging."},{"key":"B35","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1002\/nbm.1706","article-title":"Complex flow patterns in a real-size intracranial aneurysm phantom: phase contrast mri compared with particle image velocimetry and computational fluid dynamics","volume":"25","author":"van Ooij P1","year":"2012","journal-title":"NMR Biomed."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1515","DOI":"10.1007\/s10439-008-9531-y","article-title":"A parametric model for studies of flow in arterial bifurcations","volume":"36","author":"Zakaria H1","year":"2008","journal-title":"Ann Biomed Eng."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2023.1265484\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T09:50:57Z","timestamp":1697104257000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2023.1265484\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,12]]},"references-count":36,"alternative-id":["10.3389\/fneur.2023.1265484"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2023.1265484","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,12]]},"article-number":"1265484"}}