Bogdan Ciszek1, Krzysztof Cieślicki, Pawel Krajewski, Stefan K Piechnik. 1. From the Department of Descriptive and Clinical Anatomy (B.C.) and Department of Forensic Medicine (P.K.), Warsaw Medical University, Poland; Institute of Automatic Control and Robotics, Warsaw University of Technology, Poland (K.C.); and Department of Cardiovascular Medicine, University of Oxford, United Kingdom (S.K.P.).
Abstract
BACKGROUND AND PURPOSE: Intracranial bleeding is linked to hemodynamic stress factors, such as hypertension. However, there are no studies that tested the breaking pressure of normal large cerebral arteries in humans. METHODS: The brains of 10 cadavers (age, 47±14 years; 9 men) were harvested within 48 hours postmortem for 31 segments of the main intracranial arteries. After careful microsurgical preparation, the vessels were pressurized with saline and observed until they ruptured. RESULTS: Vessel diameters averaged 2.6±0.3 mm (range, 1.2-4.3 mm). The average rupture pressure was 2.21±0.59 atm (range, 1.13-4.3 atm) and decreased with age at -0.025 atm/y (R2=40%; P<0.0002). The maximum diameter distention at rupture was 30±9% (13%-52%), which also decreased with age (-0.5%/y; R2=78%; P<0.00001). Neither the rupture pressure nor the maximum distention showed significant dependence on the resting vessel diameter. No significant dependencies were found on the vessel origin, vascular configuration, direction of the rupture, or the presence of minor coexisting pathology. CONCLUSIONS: Human cerebral arterial wall breaks only at extremely high intravascular pressures, exceeding several times the highest observed systolic blood pressure, even accounting for age trends. Systolic hypertension alone may not be sufficient to cause intracranial hemorrhage, and there may be additional contributing factors.
BACKGROUND AND PURPOSE:Intracranial bleeding is linked to hemodynamic stress factors, such as hypertension. However, there are no studies that tested the breaking pressure of normal large cerebral arteries in humans. METHODS: The brains of 10 cadavers (age, 47±14 years; 9 men) were harvested within 48 hours postmortem for 31 segments of the main intracranial arteries. After careful microsurgical preparation, the vessels were pressurized with saline and observed until they ruptured. RESULTS: Vessel diameters averaged 2.6±0.3 mm (range, 1.2-4.3 mm). The average rupture pressure was 2.21±0.59 atm (range, 1.13-4.3 atm) and decreased with age at -0.025 atm/y (R2=40%; P<0.0002). The maximum diameter distention at rupture was 30±9% (13%-52%), which also decreased with age (-0.5%/y; R2=78%; P<0.00001). Neither the rupture pressure nor the maximum distention showed significant dependence on the resting vessel diameter. No significant dependencies were found on the vessel origin, vascular configuration, direction of the rupture, or the presence of minor coexisting pathology. CONCLUSIONS:Human cerebral arterial wall breaks only at extremely high intravascular pressures, exceeding several times the highest observed systolic blood pressure, even accounting for age trends. Systolic hypertension alone may not be sufficient to cause intracranial hemorrhage, and there may be additional contributing factors.
Authors: Oriane Poupart; Riccardo Conti; Andreas Schmocker; Lucio Pancaldi; Christophe Moser; Katja M Nuss; Mahmut S Sakar; Tomas Dobrocky; Hansjörg Grützmacher; Pascal J Mosimann; Dominique P Pioletti Journal: Front Bioeng Biotechnol Date: 2021-01-20