Effects of perianeurysmal environment during the growth of cerebral aneurysms: a case study.
Effects of perianeurysmal environment during the growth of cerebral aneurysms: a case study.
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DOI：
10.3174/ajnr.a2908
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发表时间：
2012-06
期刊：
影响因子：
--
通讯作者：
Cebral JR
中科院分区：
文献类型：
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作者：
Sforza DM;Putman CM;Tateshima S;Viñuela F;Cebral JR
脑动脉瘤的自然史被认为是由涉及血液动力学、生物力学、机械生物学和周围环境的多因素过程控制的。本研究的目的是强调考虑与颅内动脉瘤周围环境结构接触对颅内动脉瘤血流动力学和几何演变的影响的重要性。选择与骨接触并在4年随访期间观察到生长的基底动脉大动脉瘤进行研究。解剖模型是根据观察期内每隔1年采集的纵向CTA图像构建的。在脉动流条件下进行计算流体动力学模拟，以分析动脉瘤演变过程中的血流模式和WSS分布。观察到动脉瘤贴着骨生长，导致近端载瘤动脉的几何形状变化，进而引起动脉瘤血流动力学的实质性变化。特别是，观察到流入流产生的WSS升高区域随着动脉瘤进展而在动脉瘤扩大与骨接触的位置周围移动位置。此外，观察到动脉瘤远端附近远离骨且WSS相对较高的“凹口”生长，随后完全消失。需要考虑和分析与动脉瘤周围结构的接触，以评估它们是否会对每个颅内动脉瘤的几何演变及其血流动力学产生显著影响。
The natural history of cerebral aneurysms is thought to be governed by multifactorial processes involving hemodynamics, biomechanics, mechanobiology, and perianeurysmal environment. The purpose of this study was to highlight the importance of considering the influence of contacts with perianeurysmal environment structures on the hemodynamics and geometric evolution of intracranial aneurysms. A large aneurysm of the basilar artery in contact with bone and observed to grow during a 4-year follow-up period was selected for study. Anatomic models were constructed from longitudinal CTA images acquired at 1-year intervals during the observation period. Computational fluid dynamics simulations were carried out under pulsatile flow conditions to analyze the blood flow pattern and WSS distribution in the aneurysm during its evolution. The aneurysm was observed to grow against the bone, resulting in a geometric change of the proximal parent artery, which, in turn, induced substantial changes in the aneurysm hemodynamics. In particular, a region of elevated WSS created by the inflow streams was observed to shift locations around the place where the aneurysm enlarged in contact with the bone as the aneurysm progressed. In addition, a “notch” near the distal end of the aneurysm, away from the bone and subject to relatively high WSS, was observed to grow and, later, completely disappear. Contacts with perianeurysmal structures need to be considered and analyzed to assess whether they could exert a significant influence on the geometric evolution of each individual intracranial aneurysm and its hemodynamics.