Document Detail

Sex differences in intracranial arterial bifurcations.
MedLine Citation:
PMID:  20435277     Owner:  NLM     Status:  MEDLINE    
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.
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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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Gender medicine     Volume:  7     ISSN:  1878-7398     ISO Abbreviation:  Gend Med     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-05-03     Completed Date:  2010-07-23     Revised Date:  2011-01-24    
Medline Journal Info:
Nlm Unique ID:  101225178     Medline TA:  Gend Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  149-55     Citation Subset:  IM    
Copyright Information:
2010 Excerpta Medica Inc. All rights reserved.
Department of Clinical Medicine, University of Tromsø, Norway.
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MeSH Terms
Aged, 80 and over
Analysis of Variance
Angiography, Digital Subtraction
Blood Flow Velocity
Carotid Artery, Internal / anatomy & histology*,  physiology,  radiography
Cerebral Angiography
Genetic Predisposition to Disease / epidemiology,  genetics
Intracranial Aneurysm / epidemiology*,  etiology,  radiography
Linear Models
Middle Aged
Middle Cerebral Artery / anatomy & histology*,  physiology,  radiography
Models, Cardiovascular
Multifactorial Inheritance / genetics
New South Wales / epidemiology
Risk Factors
Sex Characteristics*
Sex Distribution
Subarachnoid Hemorrhage / epidemiology*,  etiology,  radiography

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