High curvature of the internal carotid artery is associated with the presence of intracranial aneurysms

Objective Aneurysm formation in locations not involving vascular bifurcations has not been thoroughly analyzed. This study evaluated the relationship between the degree of vessel curvature and the presence of intracranial sidewall aneurysms of the internal carotid artery (ICA). Methods Catheter-based 3D-rotational angiographic volumes and demographic data were available for 130 ICAs. Mean and peak curvatures were evaluated for the intracranial ICA (50 mm caudal from ICA bifurcation) and for its distal segment (from ICA bifurcation to carotid siphon). Four ICA groups, statistically matched for age, were identified: non-aneurysmal women (n=33) and men (n=25), aneurysmal women (n=58) and men (n=14). Univariate and multivariate analyses were employed to evaluate statistical performance. Results Aneurysmal ICAs had significantly higher mean curvatures than non-aneurysmal ICAs in both the intracranial (p<0.001) and the distal ICA (p<0.001) for both genders. Peak curvature was significantly higher in aneurysmal versus non-aneurysmal men (p=0.008) but not in aneurysmal versus non-aneurysmal women (p=0.12). Mean curvature in non-aneurysmal ICAs was lower in men than in women but higher in aneurysmal ICAs in men than in women. In multivariate analysis, curvature was highly correlated with aneurysm presence but was independent of age, hypertension, hypercholesterolemia and smoking status. Conclusions The presence of a sidewall aneurysm on the ICA is associated with high curvature in both genders. High curvature of the intracranial ICA, as well as of the distal segment, may indicate a higher risk for aneurysm formation. Non-aneurysmal ICAs are less curved in men than in women, which may explain the gender predisposition to aneurysm formation.