Department of Neurology, CHU-Hopitaux de Rouen & Institut National de la Sante et de la Recherche Medicale (INSERM) U644, Institut Federatif de Recherche Multidisciplinaire sur les Peptides (IFRMP) 23, Institute for Biomedical Research, University of Rouen, France.
Atherosclerosis. 2010 Aug;211(2):486-91. doi: 10.1016/j.atherosclerosis.2010.04.002. Epub 2010 Apr 13.
Because an underlying arteriopathy might contribute to the development of intracranial aneurysms (IAs), we assessed the elastic properties of proximal conduit arteries in patients with IA.
In 27 patients with previous ruptured IA and 27 control subjects matched for age, gender and BMI, we determined arterial pressure, internal diameter, intima-media thickness (IMT), circumferential wall stress (CWS) and elastic modulus (wall stiffness) in common carotid arteries using applanation tonometry and echotracking. Moreover, carotid augmentation index (AIx, arterial wave reflections) and carotid-to-femoral pulse wave velocity (PWV, aortic stiffness) were assessed.
Compared with controls, patients with IA exhibited higher brachial and carotid systolic and diastolic blood pressures, with similar brachial but higher carotid artery pulse pressure (35 + or - 6mm Hg vs. 41 + or - 8mm Hg, P=0.014). Moreover, patients have higher PWV (7.8 + or - 1.2ms(-1) vs. 8.3 + or - 1.1ms(-1), P=0.048) and AIx (15.8 + or - 10.8% vs. 21.1 + or - 8.5%, P<0.001) which contributes to increase carotid blood pressures. Furthermore, carotid IMT was higher in patients (546 + or - 64 microm vs. 642 + or - 70 microm, P<0.001) without difference in diameter suggesting an adaptive hypertrophy. However, patients display a lower CWS (61.6 + or - 9.2 kPa vs. 56.9 + or - 10.3 kPa, P=0.007) and no correlation between IMT and pulse pressure (r=0.152, P=NS) in contrast to controls (r=0.539, P<0.001) showing the contribution of a pressure-independent process. Finally, despite this lesser CWS, elastic modulus was increased in patients (310 + or - 105 kPa vs. 383 + or - 174 kPa, P=0.026).
This study demonstrates that patients with IA display a particular carotid artery phenotype with an exaggerated hypertrophic remodeling and altered elastic properties. Thus, a systemic arteriopathy might contribute, together with the arterial wall fatiguing effect of the increased pulsatile stress, to the pathogenesis of IA.
由于潜在的动脉病变可能导致颅内动脉瘤（IA）的发生，因此我们评估了 IA 患者近端血管的弹性特性。
在 27 例既往破裂的 IA 患者和 27 例年龄、性别和 BMI 匹配的对照组中，我们使用平板压力测量法和回声跟踪法测定颈总动脉的动脉压、内径、内膜中层厚度（IMT）、周向壁应力（CWS）和弹性模量（壁硬度）。此外，评估了颈动脉增强指数（AIx，动脉波反射）和颈动脉-股动脉脉搏波速度（PWV，主动脉僵硬度）。
与对照组相比，IA 患者的肱动脉和颈总动脉收缩压和舒张压均升高，而肱动脉血压相似，但颈总动脉脉压较高（35+/-6mmHg 与 41+/-8mmHg，P=0.014）。此外，患者的 PWV（7.8+/-1.2ms(-1) 与 8.3+/-1.1ms(-1)，P=0.048）和 AIx（15.8+/-10.8% 与 21.1+/-8.5%，P<0.001）更高，这导致颈动脉血压升高。此外，IA 患者的颈动脉 IMT 更高（546+/-64μm 与 642+/-70μm，P<0.001），而直径无差异，提示适应性肥大。然而，与对照组相比（r=0.539，P<0.001），患者的 CWS 较低（61.6+/-9.2kPa 与 56.9+/-10.3kPa，P=0.007），而 IMT 与脉压之间无相关性（r=0.152，P=NS），表明存在压力独立过程。最后，尽管 CWS 较低，但患者的弹性模量增加（310+/-105kPa 与 383+/-174kPa，P=0.026）。
这项研究表明，IA 患者表现出特定的颈动脉表型，具有明显的肥大重塑和弹性特性改变。因此，全身性动脉病变可能与增加的脉动压力对动脉壁的疲劳作用一起，导致 IA 的发病机制。
