Y-Stent Coiling of Basilar Bifurcation Aneurysms Induces a Dynamic Angular Vascular Remodeling With Alteration of the Apical Wall Shear Stress Pattern
Y-Stent Coiling of Basilar Bifurcation Aneurysms Induces a Dynamic Angular Vascular Remodeling With Alteration of the Apical Wall Shear Stress Pattern
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DOI：
10.1227/neu.0b013e3182846d9f
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发表时间：
2013-04-01
期刊：
影响因子：
4.8
通讯作者：
Malek, Adel M.
中科院分区：
文献类型：
--
作者：
Gao, Bulang;Baharoglu, Merih I.;Malek, Adel M.
背景技术：虽然宽颈基底动脉分叉部动脉瘤的治疗与Y型支架弹簧圈，这种干预对血管构型和血流动力学的影响是unknown.OBJECTIVE：调查的即时和延迟的影响Y型支架使用自膨式微型支架对基底动脉分叉部architecture和血流动力学.METHODS：15例患者进行基底动脉Y型支架弹簧圈和成像与旋转血管造影。在前后矢状面和伽玛矢状面测量大脑后动脉（α）近端P1段之间以及基底动脉和每个P1段（β（1，2））之间的血管角。采用患者特异性计算流体动力学分析来估计治疗过程中壁面剪切应力（WSS）的变化。结果：在前后平面，Y型支架置入显著降低了α角，并在支架卷绕后立即增加了β角（分别为P <0.05和P <0.01）持续的动态重塑在随后的几个月中进一步进展;矢状面γ角也减小（P <0.0001）。这种新型支架诱导的几何渐进性重塑导致基底动脉分叉角α有效变直和变窄（150.0度vs 113度，P < .0001），治疗前近端P1角与最大角度变化之间存在显著相关性（r = 0.39，P < .05）。计算流体动力学分析表明，角度重塑导致显着缩小的WSS interpeak在顶点，重定向高WSS远离颈部过渡区与原生血管对惰性coil mass.CONCLUSION：Y型配置支架弹簧圈诱导立即，更重要的是，以前未定义的延迟脑血管重塑。这种进行性支架诱导的角度重塑改变了动脉瘤周围的血流动力学，与支架支柱的血流转向特性无关，从而改变了影响动脉瘤发展和演变的血流动力学力的平衡。
BACKGROUND: Although wide-necked basilar bifurcation aneurysms are treated with Y-stent coiling, the effect of this intervention on vessel configuration and hemodynamics is unknown.OBJECTIVE: To investigate the immediate and delayed effects of Y-stenting using self-expanding microstents on basilar bifurcation architecture and hemodynamics.METHODS: Fifteen patients underwent basilar Y-stent coiling and imaging with rotational angiography. Vascular angles were measured between proximal P1 segments of the posterior cerebral arteries (alpha) and between the basilar artery and each P1 segment (beta(1,2)) in the anteroposterior and gamma(1,2) sagittal planes. Patient-specific computational fluid dynamic analysis was used to estimate wall shear stress (WSS) changes with treatment.RESULTS: In the anteroposterior plane, Y-stenting significantly decreased angle alpha and increased beta angles immediately after stent coiling (P < .05 and P < .01, respectively) in a continued dynamic remodeling that progressed further in later months; sagittal gamma angles also decreased (P < .0001). This novel stent-induced geometric progressive remodeling resulted in effective straightening and narrowing of the basilar bifurcation angle alpha (150.0 degrees vs 113 degrees, P < .0001) with significant correlation (r = 0.39, P < .05) between pretreatment proximal P1 angles and maximal angular change. Computational fluid dynamic analysis showed the angular remodeling led to significant narrowing of the WSS interpeak at the apex, redirecting high WSS away from the neck transition zone with native vessel toward the inert coil mass.CONCLUSION: Y-configuration stent coiling induced immediate and, more significantly, a previously undefined delayed cerebrovascular remodeling. This progressive stent-induced angular remodeling alters perianeurysmal hemodynamics, independent of the flow-diverting properties of stent struts, thus shifting the balance of hemodynamic forces affecting aneurysm development and evolution.