Narrowings of the Deep Cerebral Perforating Arteries Ostia: Geometry, Structure, and Clinical Implications

Background and Purpose The pathogenesis of neurovascular diseases and various types of dementia is tightly connected to cerebral circulation. An area that requires further exploration is the system of deep cerebral perforating arteries—arteries branching directly from high-pressure intracranial arte...

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Main Authors: Radosław Rzepliński, Sylwia Tarka, Michał Tomaszewski, Michał Kucewicz, Albert Acewicz, Jerzy Małachowski, Bogdan Ciszek
Format: Article
Language:English
Published: Korean Stroke Society 2025-01-01
Series:Journal of Stroke
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Online Access:http://j-stroke.org/upload/pdf/jos-2024-01655.pdf
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author Radosław Rzepliński
Sylwia Tarka
Michał Tomaszewski
Michał Kucewicz
Albert Acewicz
Jerzy Małachowski
Bogdan Ciszek
author_facet Radosław Rzepliński
Sylwia Tarka
Michał Tomaszewski
Michał Kucewicz
Albert Acewicz
Jerzy Małachowski
Bogdan Ciszek
author_sort Radosław Rzepliński
collection DOAJ
description Background and Purpose The pathogenesis of neurovascular diseases and various types of dementia is tightly connected to cerebral circulation. An area that requires further exploration is the system of deep cerebral perforating arteries—arteries branching directly from high-pressure intracranial arteries, supplying vital neural structures such as the internal capsule, and characterized by a diameter of well below 1 mm, which makes them difficult to visualize with standard radiological examinations. This study aimed to analyze the morphology of the perforator origins, which constitute connection points between high-pressure intracranial arteries and microcirculation. Methods Twenty-three human basal ganglia specimens with the middle cerebral artery (MCA, including 172 perforating arteries) and ten brainstem specimens with the basilar artery (BA, including 162 perforating arteries) were prepared and scanned using microcomputed tomography. The geometry and structure of the perforating arteries were analyzed using radiological images and additional histological studies. Results The ostia of the perforating arteries were ellipsoidal in shape with median stenosis severity of 23% and 20% for MCA and BA perforators, respectively. The local narrowing structure was typical of neointimal hyperplasia. Statistical analysis revealed that the severity of stenosis may be related to age and cardiovascular health. Conclusion Origins of the deep cerebral perforators are locally narrowed by neointimal hyperplasia, which may be a protective mechanism to adjust high blood pressure to the microcirculation. The narrowings may lead to chronic hypoperfusion and play a role in the pathophysiology of cerebral small vessel disease.
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spelling doaj-art-6c64f3d55be04aa18e4d798c428fe95e2025-08-20T03:03:08ZengKorean Stroke SocietyJournal of Stroke2287-63912287-64052025-01-01271526410.5853/jos.2024.01655560Narrowings of the Deep Cerebral Perforating Arteries Ostia: Geometry, Structure, and Clinical ImplicationsRadosław Rzepliński0Sylwia Tarka1Michał Tomaszewski2Michał Kucewicz3Albert Acewicz4Jerzy Małachowski5Bogdan Ciszek6 Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland Department of Neuropathology, Institute of Psychiatry and Neurology, Warsaw, Poland Institute of Mechanics and Computational Engineering, Faculty of Mechanical Engineering, Military University of Technology, Warsaw, Poland Institute of Mechanics and Computational Engineering, Faculty of Mechanical Engineering, Military University of Technology, Warsaw, Poland Department of Neuropathology, Institute of Psychiatry and Neurology, Warsaw, Poland Institute of Mechanics and Computational Engineering, Faculty of Mechanical Engineering, Military University of Technology, Warsaw, Poland Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, PolandBackground and Purpose The pathogenesis of neurovascular diseases and various types of dementia is tightly connected to cerebral circulation. An area that requires further exploration is the system of deep cerebral perforating arteries—arteries branching directly from high-pressure intracranial arteries, supplying vital neural structures such as the internal capsule, and characterized by a diameter of well below 1 mm, which makes them difficult to visualize with standard radiological examinations. This study aimed to analyze the morphology of the perforator origins, which constitute connection points between high-pressure intracranial arteries and microcirculation. Methods Twenty-three human basal ganglia specimens with the middle cerebral artery (MCA, including 172 perforating arteries) and ten brainstem specimens with the basilar artery (BA, including 162 perforating arteries) were prepared and scanned using microcomputed tomography. The geometry and structure of the perforating arteries were analyzed using radiological images and additional histological studies. Results The ostia of the perforating arteries were ellipsoidal in shape with median stenosis severity of 23% and 20% for MCA and BA perforators, respectively. The local narrowing structure was typical of neointimal hyperplasia. Statistical analysis revealed that the severity of stenosis may be related to age and cardiovascular health. Conclusion Origins of the deep cerebral perforators are locally narrowed by neointimal hyperplasia, which may be a protective mechanism to adjust high blood pressure to the microcirculation. The narrowings may lead to chronic hypoperfusion and play a role in the pathophysiology of cerebral small vessel disease.http://j-stroke.org/upload/pdf/jos-2024-01655.pdfcerebrovascular circulationcerebral small vessel diseasesneuroanatomydementiabrain agingintracranial stenosis
spellingShingle Radosław Rzepliński
Sylwia Tarka
Michał Tomaszewski
Michał Kucewicz
Albert Acewicz
Jerzy Małachowski
Bogdan Ciszek
Narrowings of the Deep Cerebral Perforating Arteries Ostia: Geometry, Structure, and Clinical Implications
Journal of Stroke
cerebrovascular circulation
cerebral small vessel diseases
neuroanatomy
dementia
brain aging
intracranial stenosis
title Narrowings of the Deep Cerebral Perforating Arteries Ostia: Geometry, Structure, and Clinical Implications
title_full Narrowings of the Deep Cerebral Perforating Arteries Ostia: Geometry, Structure, and Clinical Implications
title_fullStr Narrowings of the Deep Cerebral Perforating Arteries Ostia: Geometry, Structure, and Clinical Implications
title_full_unstemmed Narrowings of the Deep Cerebral Perforating Arteries Ostia: Geometry, Structure, and Clinical Implications
title_short Narrowings of the Deep Cerebral Perforating Arteries Ostia: Geometry, Structure, and Clinical Implications
title_sort narrowings of the deep cerebral perforating arteries ostia geometry structure and clinical implications
topic cerebrovascular circulation
cerebral small vessel diseases
neuroanatomy
dementia
brain aging
intracranial stenosis
url http://j-stroke.org/upload/pdf/jos-2024-01655.pdf
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