Update: Middle cerebral artery tortuosity

Middle cerebral artery tortuosity

High tortuosity and small diameter are related to middle cerebral artery atherosclerosis, probably by altering hemodynamics. Different degree of tortuosity may be one of the reasons for individual differences in location of cerebral atherosclerosis 1).

Blood vessel tortuosity may play an important role in the development of vessel abnormalities such as aneurysms.

Kliś et al., performed a computer-aided analysis of (MCA) tortuosity, especially among patients diagnosed with Middle cerebral artery aneurysms.

Anatomy of the MCAs of 54 patients with unruptured middle cerebral artery aneurysms was retrospectively analyzed, as was that of 54 sex-, age-, and vessel side-matched control patients without MCA aneurysms. From medical records, Kliś et al., obtained each patient’s medical history including previous and current diseases and medications. For each patient, they calculated the following tortuosity descriptors: relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD), and inflection count metric (ICM).

Patients with an MCA aneurysm had significantly lower RLs (0.75 ± 0.09 vs 0.83 ± 0.08, p < 0.01), SOAMs (0.45 ± 0.10 vs 0.60 ± 0.17, p < 0.01), and PADs (0.34 ± 0.09 vs 0.50 ± 0.17, p < 0.01). They also had significantly higher TIs (0.87 ± 0.04 vs 0.81 ± 0.07, p < 0.01) and ICMs (3.07 ± 1.58 vs 2.26 ± 1.12, p < 0.01). Female patients had significantly higher RLs (0.76 ± 0.11 vs 0.80 ± 0.09, p = 0.03) than male patients.

Middle cerebral artery aneurysm formation is strongly associated with blood vessel tortuosity parameters, which can potentially be used to screen for patients at risk for MCA aneurysm formation 2).

The results of a study suggest that a tortuous M1 may be associated with unsuccessful recanalization using the Merci retrieval system, even when and adjunctive treatments are used, although this finding should be confirmed in a larger population 3).



Kim BJ, Kim SM, Kang DW, Kwon SU, Suh DC, Kim JS. Vascular tortuosity may be related to intracranial artery atherosclerosis. Int J Stroke. 2015 Oct;10(7):1081-6. doi: 10.1111/ijs.12525. Epub 2015 Jun 9. PubMed PMID: 26061533.


Kliś KM, Krzyżewski RM, Kwinta BM, Stachura K, Moskała M, Tomaszewski KA. Computer-aided analysis of middle cerebral artery tortuosity: association with aneurysm development. J Neurosurg. 2018 May 18:1-7. doi: 10.3171/2017.12.JNS172114. [Epub ahead of print] PubMed PMID: 29775150.


Yamamoto S, Yamagami H, Todo K, Kuramoto Y, Ishikawa T, Imamura H, Ueno Y, Adachi H, Kohara N, Sakai N. Correlation of middle cerebral artery tortuosity with successful recanalization using the Merci retrieval system with or without adjunctive treatments. Neurol Med Chir (Tokyo). 2014;54(2):113-9. Epub 2013 Oct 25. PubMed PMID: 24162242; PubMed Central PMCID: PMC4508709.

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