Flow dynamics in a fatal aneurysm of the basilar artery.
Flow dynamics in a fatal aneurysm of the basilar artery.
复制标题
基底动脉致命性动脉瘤的血流动力学。
DOI：
10.1016/s1350-4533(03)00078-x
复制
发表时间：
1996
期刊：
影响因子：
--
通讯作者：
H. Meltzer
中科院分区：
文献类型：
--
作者：
Charles W. Kerber;S. Hecht;K. Knox;Richard B. Buxton;H. Meltzer
目的
研究致命性基底动脉瘤的血流动力学。
方法
我们做了一个老年病人的椎基底动脉的透明弹性复制品，他死于基底动脉瘤破裂。使用非牛顿流体，生理脉动流量和配置文件，等压染料和颗粒，我们观察和记录滑流，因为它们进入动脉瘤，同时改变椎动脉中的相对流量。最后，我们在动脉瘤上放置夹子，留下残留物（或狗耳），并观察滑流。
结果
动脉瘤从迂曲基底动脉的大弯侧向起源，测量值为19 x 11 x 12 mm，在破裂部位的尖端有一个墨菲乳头。颈部尺寸为10 x 4 mm，约为基底动脉的直径。滑流在椎动脉汇合处汇合，形成螺旋状流动模式，并猛烈地进入动脉瘤，撞击顶点。然后从近端囊壁周围通过，然后从中央通过，最后重新进入基底动脉并从远端通过。改变椎动脉中的相对流量可以改变并防止滑流流入动脉瘤。当动脉瘤夹放置不正确而形成狗耳状时，滑流仅进入位于动脉瘤夹远端的狗耳状。正确放置的夹子将动脉瘤从循环中排除，但没有使血流动力学恢复正常。
结论
高速滑流撞击破裂部位的动脉瘤，对远端而非近端的狗耳有影响。改变相对流量可以防止不稳定的填充。此外，血流动力学的知识可以让我们预测哪些动脉瘤有扩大和破裂的风险，并可以帮助指导适当的治疗。
PURPOSE
To examine the flow dynamics in a fatal aneurysm of the basilar artery in humans.
METHODS
We made transparent elastic replicas of the vertebrobasilar arteries of an elderly patient who died of a ruptured aneurysm in the basilar artery. Using non-Newtonian fluid, physiological pulsatile flow volumes and profiles, and isobaric dyes and particles, we observed and recorded the slipstreams as they entered the aneurysm while changing relative flow in the vertebral arteries. Finally, we placed clips on the aneurysm, leaving residuals (or dog-ears), and observed the slipstreams.
RESULTS
The aneurysm originated laterally from the greater curvature of a tortuous basilar artery, measured 19 x 11 x 12 mm, and had a Murphy's teat at the apex, the rupture site. The neck measured 10 x 4 mm, about the diameter of the basilar artery. Slipstreams joined at the confluence of the vertebral arteries, formed helical flow patterns, and entered the aneurysm violently, striking the apex. They then passed proximally around the sac walls, then centrally, and finally reentered the basilar artery to pass distally. Altering the relative flows in the vertebral arteries could modify and prevent slipstream flow into the aneurysm. When a dog-ear was created by incorrect placement of an aneurysm clip, slipstreams entered only dog-ears that lay distal to the clip. Correctly placed clips excluded the aneurysm from the circulation, but did not return the flow dynamics to normal.
CONCLUSION
High-velocity slipstreams strike aneurysms at their rupture site and have an impact on distal but not proximal dog-ears. Modifying relative flow may prevent aneurysmal filling. Further, a knowledge of flow dynamics may allow us to predict which aneurysms are at risk of enlarging and rupturing, and may help guide proper therapy.