Highlights
- •A multi-scale model of vertebral arteries, basilar artery and circle of Willis was built.
- •Unbalanced vertebral arteries increase wall shear stress at certain side of basilar artery.
- •Missing of posterior communicating arteries markedly increases blood pressure in basilar artery.
Abstract
Background
Vertebrobasilar dolichoectasia is a rare cerebrovascular disease characterized by
obvious extension, dilation and tortuosity of vertebrobasilar artery, and its pathophysiological
mechanism is not clear. This study focused on local hemodynamic changes in basilar
arteries with typical vertebrobasilar dolichoectasia, together with unbalanced vertebral
arteries and abnormal structures of the circle of Willis, through multi-scale modeling.
Methods
Three-dimensional models of 3 types of vertebrobasilar arteries were constructed from
magnetic resonance images. The first type has no vertebrobasilar dolichoectasia, the
second type has vertebrobasilar dolichoectasia and balanced vertebral arteries, and
the third type has vertebrobasilar dolichoectasia and unbalanced vertebral arteries.
A lumped parameter model of the circle of Willis was established and coupled to these
three-dimensional models.
Findings
The results showed that unbalanced bilateral vertebral arteries, especially single
vertebral artery deletion mutation, might associate with higher wall shear stress
on anterior wall of basilar artery in patients with vertebrobasilar dolichoectasia.
And unbalanced bilateral vertebral arteries would increase the blood pressure in basilar
artery. Meanwhile, missing communicating arteries in the circle of Willis, especially
bilateral posterior communicating arteries absences, would significantly increase
blood pressure in basilar artery. The unilateral absence of posterior communicating
arteries would increase differences in blood flow between the left and right posterior
cerebral arteries.
Interpretation
This study provided a multi-scale modeling method and some preliminary results for
helping understand the role of hemodynamics in occurrence and development of vertebrobasilar
dolichoectasia.
Keywords
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References
- Flows in stenotic vessels.Annu. Rev. Fluid Mech. 2000; 32: 347-382https://doi.org/10.1146/annurev.fluid.32.1.347
- Hemodynamic characteristics of stable and unstable vertebrobasilar dolichoectatic and fusiform aneurysms.J. Neurointerv. Surg. 2018; 10: 1102-1107https://doi.org/10.1136/neurintsurg-2018-013756
- Dilatative arteriopathy (dolichoectasia): what is known and not known.Ann. Neurol. 2005; 57: 469-471https://doi.org/10.1002/ana.20447
- Mechanotransduction in response to shear stress. Roles of receptor tyrosine kinases, integrins, and Shc.J. Biol. Chem. 1999; 274: 18393-18400https://doi.org/10.1074/jbc.274.26.18393
- Endothelial cells in physiology and in the pathophysiology of vascular disorders.Blood. 1998; 91: 3527-3561https://doi.org/10.1006/bcmd.1998.0187
- Treatment options in vertebrobasilar dolichoectasia — case report and review of the literature.Eur. Neurol. 2003; 49: 245-247https://doi.org/10.1159/000070196
- The natural history of radiographically defined vertebrobasilar nonsaccular intracranial aneurysms.Cerebrovasc. Dis. 2005; 20: 270-279https://doi.org/10.1159/000087710
- Certain histological and chemical responses of the vascular interface to acutely induced mechanical stress in the aorta of the dog.Circ. Res. 1969; 24: 93-108https://doi.org/10.1161/01.RES.24.1.93
- Dolichoectatic intracranial arteries. Association with aneurysms of the abdominal aorta.Rev. Neurol. 1988; 144: 437-446https://doi.org/10.1002/mus.880110102
- Dolichoectasia-an evolving arterial disease.Nat. Rev. Neurol. 2011; 7: 41-50https://doi.org/10.1038/nrneurol.2010.181
- Circle of Willis configuration as a determinant of intracranial dolichoectasia.Cerebrovasc. Dis. 2013; 36: 446-453https://doi.org/10.1159/000356347
- Handbook of Cerebrovascular Disease and Neurointerventional Technique.Springer, 2018: 153-185
- In vivo assessment of rapid cerebrovascular morphological adaptation following acute blood flow increase.J. Neurosurg. 2008; 109: 1141-1147https://doi.org/10.3171/JNS.2008.109.12.1141
- Vertebral artery dominance contributes to basilar artery curvature and peri-vertebrobasilar junctional infarcts.J. Neurol. Neurosurg. Psychiatry. 2009; 80: 1087-1092https://doi.org/10.1136/jnnp.2008.169805
- Different effects of orbital shear stress on vascular endothelial cells: comparison with the results of in vivo study with rats.Vasc. Specialist Int. 2015; 31: 33-40https://doi.org/10.5758/vsi.2015.31.2.33
- Flow-dependent remodeling of small arteries: the stimuli and the sensors are (still) in question.Circ. Res. 2006; 99: 6-9https://doi.org/10.1161/01.RES.0000233144.65663.23
- Flow-induced vascular remodeling in the mouse: a model for carotid intima-media thickening.Arterioscler. Thromb. Vasc. Biol. 2003; 23: 2185-2191https://doi.org/10.1161/01.ATV.0000103120.06092.14
- Reductions in arterial diameter produced by chronic decreases in blood flow are endothelium-dependent.Science. 1986; 231: 405-407https://doi.org/10.1126/science.3941904
- Molecular mechanisms of the vascular responses to haemodynamic forces.J. Intern. Med. 2006; 259: 381-392https://doi.org/10.1111/j.1365-2796.2006.01624.x
- Three-dimensional hemodynamics analysis of the circle of Willis in the patient-specific nonintegral arterial structures.Biomech. Model. Mechanobiol. 2016; 15: 1439-1456https://doi.org/10.1007/s10237-016-0773-6
- Vertebrobasilar dilatative arteriopathy (dolichoectasia).Ann. N. Y. Acad. Sci. 2010; 1184: 121-133https://doi.org/10.1111/j.1749-6632.2009.05114.x
- Complex hemodynamics at the apex of an arterial bifurcation induces vascular remodeling resembling cerebral aneurysm initiation.Stroke. 2007; 38: 1924-1931https://doi.org/10.1161/STROKEAHA.106.481234
- High WSS or low WSS? Complex interactions of hemodynamics with intracranial aneurysm initiation, growth, and rupture: toward a unifying hypothesis.AJNR Am. J. Neuroradiol. 2013; 35: 1254-1262https://doi.org/10.3174/ajnr.A3558
- Hemodynamics in the abdominal aorta: a comparison of in vitro and in vivo measurements.J. Appl. Physiol. 1994; 76: 1520-1527https://doi.org/10.1152/jappl.1994.76.4.1520
- Clinicoradiologic features of vertebrobasilar dolichoectasia in stroke patients.J. Stroke Cerebrovasc. Dis. 2012; 21: 5-10https://doi.org/10.1016/j.jstrokecerebrovasdis.2010.04.003
- Change in basilar artery length and bending according to aging and vertebral artery dominance: a longitudinal study.Sci. Rep. 2020; 10: 8904https://doi.org/10.1016/j.jns.2013.12.037
- Repositioning of the tortuous vertebrobasilar artery for trigeminal neuralgia: a technical note.Surg. Neurol. 1992; 38: 232-235https://doi.org/10.1016/0090-3019(92)90174-L
- Posterior circulation infarcts in patients with vertebrobasilar dolichoectasia.Stroke. 1998; 29: 653-659https://doi.org/10.1161/01.STR.29.3.653
- Intracranial arterial dolichoectasia and its relation with atherosclerosis and stroke subtype.Neurology. 2003; 61: 1736-1742https://doi.org/10.1212/01.WNL.0000103168.14885.A8
- Association of small-vessel disease with dilatative arteriopathy of the brain neuropathologic evidence.Stroke. 2007; 38: 1197-1202https://doi.org/10.1161/01.STR.0000259708.05806.76
- Pathophysiology, presentation, prognosis, and management of intracranial arterial dolichoectasia.Lancet Neurol. 2015; 14: 833-845https://doi.org/10.1016/S1474-4422(15)00089-7
- Arterial enlargement in response to high flow requires early expression of matrix metalloproteinases to degrade extracellular matrix.Exp. Mol. Pathol. 2002; 73: 142-153https://doi.org/10.1006/exmp.2002.2457
- Magnitude and role of wall shear stress on cerebral aneurysm: computational fluid dynamic study of 20 middle cerebral artery aneurysms.Stroke. 2004; 35: 2500-2505https://doi.org/10.1161/01.STR.0000144648.89172.0f
- Evaluation of cerebral blood flow in acute ischemic stroke patients with atrial fibrillation: a sonographic study.J. Formos. Med. Assoc. 2016; 116: 287-294https://doi.org/10.1016/j.jfma.2016.05.009
- Possible morphological pathomechanisms of ischemic stroke in the posterior circulation of patients with vertebral artery hypoplasia.J. Neuroimaging. 2015; 25: 408-414https://doi.org/10.1111/jon.12137
- Basilar artery diameter is an independent predictor of incident cardiovascular events.Arterioscler. Thromb. Vasc. Biol. 2013; 33: 2240-2244https://doi.org/10.1161/ATVBAHA.113.301467
- Vertebral basilar system dolichoectasia with marked infiltration of IgG4-containing plasma cells: a manifestation of IgG4-related disease?.Neuropathology. 2012; 32: 100-104https://doi.org/10.1111/j.1440-1789.2011.01227.x
- Role of matrix metalloproteinases in blood flow-induced arterial enlargement: interaction with NO.Arterioscler. Thromb. Vasc. Biol. 2000; 20: E120-E126https://doi.org/10.1161/01.ATV.20.12.e120
- Vertebrobasilar dolichoectasia diagnosed by magnetic resonance angiography and risk of stroke and death: a cohort study.J. Neurol. Neurosurg. Psychiatry. 2004; 75: 22-26https://doi.org/10.1136/jnnp.2003.034256
- Vertebral and/or basilar dolichoectasia in human adult cadavers.Acta Neurochir. 2012; 154: 1477-1488https://doi.org/10.1007/s00701-012-1400-7
- Hemodynamic characteristics of the vertebrobasilar system analyzed using MRI-based models.PLoS One. 2012; 7e51346https://doi.org/10.1371/journal.pone.0051346
- Research Progress on Vertebrobasilar Dolichoectasia.Int. J. Med. Sci. 2014; 11: 1039-1048https://doi.org/10.7150/ijms.8566
- Modeling the circle of Willis to assess the effect of anatomical variations on the development of unilateral internal carotid artery stenosis.Biomed. Mater. Eng. 2014; 24: 491-499https://doi.org/10.3233/bme-130835
- Basilar artery bending length, vascular risk factors, and pontine infarction.J. Neurol. Sci. 2014; 338: 142-147https://doi.org/10.1016/j.jns.2013.12.037
Article info
Publication history
Published online: December 06, 2022
Accepted:
December 5,
2022
Received:
August 24,
2021
Identification
Copyright
© 2022 Published by Elsevier Ltd.
