Proximal stenosis may induce initiation of cerebral aneurysms by increasing wall shear stress and wall shear stress gradient
Proximal stenosis may induce initiation of cerebral aneurysms by increasing wall shear stress and wall shear stress gradient
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DOI：
10.1002/cnm.2637
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发表时间：
2014-10-01
影响因子：
2.1
通讯作者：
Terada, Tomoaki
中科院分区：
文献类型：
--
作者：
Kono, Kenichi;Fujimoto, Takeshi;Terada, Tomoaki
血流动力学参数，如壁面切应力（WSS），WSS梯度（WSSG），动脉瘤形成指标（AFI），或梯度振荡数（GON），已被提出与脑动脉瘤的启动。然而，这种情况如何发生在人类身上尚不清楚。我们遇到了一个罕见而有趣的案例来解决这个问题。一名患者有一个新形成的动脉瘤，近端狭窄，这是由系列成像证实。我们制作了两个动脉瘤前模型：一个有狭窄，另一个没有狭窄。我们对这些模型进行了计算流体动力学模拟。由于狭窄引起的射流，动脉瘤起始部位的最大WSS和WSSG分别约为两倍和三倍。然而，振荡剪切指数（OSI），AFI和GON并没有因狭窄而发生实质性变化。使用近端狭窄程度不同、距离不同的人工血管模型进行的计算机模拟表明，振荡剪切指数、AFI和GON不会因狭窄而发生实质性变化。这些结果表明，近端狭窄导致动脉瘤起始部位的高WSS和高WSSG，可能导致动脉瘤起始。近端狭窄可能是通过增加WSS和WSSG诱发一类脑动脉瘤发生的潜在因素。版权所有（c）2014约翰威利父子有限公司
Hemodynamic parameters, such as wall shear stress (WSS), WSS gradient (WSSG), aneurysm formation indicator (AFI), or gradient oscillatory number (GON), have been proposed to be linked to initiation of cerebral aneurysms. However, how such conditions occur in humans is unclear. We encountered a rare and interesting case to address this issue. A patient had a newly formed aneurysm with proximal stenosis, which was confirmed by serial imagings. We made two pre-aneurysm models: one with stenosis and the other without stenosis. We performed computational fluid dynamics simulations for these models. Owing to jet flow caused by the stenosis, the maximum WSS and WSSG on the aneurysm initiation site were approximately doubled and tripled, respectively. However, the oscillatory shear index (OSI), AFI, and GON did not change substantially by the stenosis. Computer simulations using artificial vascular models with different degrees of proximal stenosis at different distances demonstrated that oscillatory shear index, AFI, and GON did not change substantially by the stenosis. These results showed that proximal stenosis caused high WSS and high WSSG at the aneurysm initiation site, possibly leading to aneurysm initiation. Proximal stenosis may be a potential factor to induce initiation of one class of cerebral aneurysms by increasing WSS and WSSG. Copyright (c) 2014 John Wiley & Sons, Ltd.