Hemodynamic characteristics of large unruptured internal carotid artery aneurysms prior to rupture: a case control study
Hemodynamic characteristics of large unruptured internal carotid artery aneurysms prior to rupture: a case control study
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DOI：
10.1136/neurintsurg-2014-011577
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发表时间：
2016-04-01
影响因子：
4.8
通讯作者：
Yang, Xinjian
中科院分区：
文献类型：
--
作者：
Liu, Jian;Fan, Jixing;Yang, Xinjian
目的颅内动脉瘤破裂后的几何模型已广泛应用于计算流体动力学研究，以评估与动脉瘤破裂相关的血流动力学参数。然而，由于动脉瘤破裂后的形态学变化，他们的结果可能无效。我们的目的是确定动脉瘤破裂前的血流动力学特征与未破裂aneurysms.Materials和Methods相比，我们回顾性地确定了三个大的未破裂的颈内动脉（伊卡）动脉瘤（预破裂组）与足够的图像质量破裂前。对照组为8例未破裂动脉瘤，均为同一时间段内位置相同、大小相似的动脉瘤。结果与未破裂动脉瘤相比，破裂前动脉瘤具有更不规则的动脉瘤形状，更高的纵横比，和更低的动脉瘤平均壁剪切应力（WSS）（p=0.024，p=0.048，和p=0.048，分别）。虽然预破裂动脉瘤有一个较低的低WSS面积和较高的振荡剪切指数，这些都没有统计学意义。结论对于大型未破裂伊卡动脉瘤，低WSS，高纵横比，和不规则的形状是致命性破裂的指标。早期使用血流导向器和弹簧圈治疗此类病变可能是最佳的治疗选择。
Objective Post-ruptured intracranial aneurysm geometry models have been widely used in computational fluid dynamic studies to assess hemodynamic parameters associated with aneurysm rupture. However, their results may not be valid due to the morphological changes of the aneurysm after rupture. Our aim was to identify the hemodynamic features of aneurysms prior to rupture in comparison with unruptured aneurysms.Materials and methods We retrospectively identified three large unruptured internal carotid artery (ICA) aneurysms (pre-ruptured group) with adequate image quality just before rupture. Matched with the same location and similar size, eight unruptured aneurysms (unruptured group) were selected as controls during the same time period. Flow simulations for these aneurysms were performed to compare differences in hemodynamics.Results Compared with unruptured aneurysms, preruptured aneurysms had a significantly more irregular aneurysm shape, a higher aspect ratio, and lower aneurysm averaged wall shear stress (WSS) (p=0.024, p=0.048, and p=0.048, respectively). Although preruptured aneurysms had a lower low WSS area and higher Oscillatory Shear Index, these were not statistically significant.Conclusions For large unruptured ICA aneurysms, low WSS, higher aspect ratio, and irregular shape were indicators of fatal rupture. Early treatment for such lesions with flow diverter and coils may be the best therapeutic option.