Hemodynamic effects of intracranial aneurysms from stent-induced straightening of parent vessels by stent-assisted coiling embolization
Hemodynamic effects of intracranial aneurysms from stent-induced straightening of parent vessels by stent-assisted coiling embolization
复制标题
通过支架辅助弹簧圈栓塞支架诱导载瘤血管伸直对颅内动脉瘤的血流动力学影响。
DOI：
10.1177/1591019921995334
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发表时间：
2021-02-27
影响因子：
1.7
通讯作者：
Xiang, Jianping
中科院分区：
文献类型：
--
作者：
Leng, Xiaochang;Wan, Hailin;Xiang, Jianping
背景颅内动脉瘤的支架辅助弹簧圈栓塞（SACE）治疗会导致载瘤血管变直。本研究旨在研究支架诱导血管拉直引起的血流动力学异常改变。方法采用有限元方法，分别在术前（未拉直，NS）和术后（拉直，S）血管模型上，对1例经SACE治疗的远端分叉部动脉瘤进行支架和弹簧圈的置入。然后对8个模型进行计算流体动力学分析，包括（I）仅NS模型、（II）NS+支架模型、（III）NS+弹簧圈模型、（IV）NS+支架+弹簧圈模型、（V）仅S模型、（VI）S+支架模型、（VII）S+弹簧圈模型和（VIII）S+支架+弹簧圈模型。最后，定性和定量地分析了不同温度下的流速、等流速面和壁面切应力的变化。结果S模型的血流量明显低于NS模型。在NS模型和S模型中，弹簧圈阻断了大部分流入动脉瘤囊的血流，血管拉直对高动脉瘤流量减少的影响比弹簧圈更深远，而支架植入对流量减少产生不利影响。以仅NS模型为基线（100%），模型II至VIII的囊平均流速为112%、36%、42%、45%、39%、12%、13%，高流量为119%、21%、30%、10%、8%、3%、3%，而囊平均WSS为106%、37%、44%、41%，35%、17%和24%。结论支架诱导血管拉直联合弹簧圈栓塞术对血流动力学的改善效果最好，可降低复发率，而支架植入术对血流动力学的改变有不良影响。
Background Straightening of parent vessels happens for stent-assisted coiling embolization (SACE) treatment of intracranial aneurysms. This study aims to investigate aneurysmal hemodynamic modifications caused by stent-induced vessel straightening. Methods Stent and coil deployments of a SACE-treated distal bifurcation aneurysm by finite element method were performed first with the preoperative (not straightened, NS) and postoperative (straightened, S) vessel models respectively. Computational fluid dynamics were then performed for eight models, including (I) NS only model, (II) NS+stent model, (III) NS+coils model, (IV) NS+stent+coils model, (V) S only model, (VI) S+stent model, (VII) S+coils model, and (VIII) S+stent+coils model. Finally, changes in aneurysmal flow velocity, isovelocity surface and wall shear stress (WSS) were analyzed qualitatively and quantitatively. Results The flow was less in the S models than that in the corresponding NS models. Coils blocked most of the flow into the aneurysm sac in both NS models and S models and vessel straightening had more profound effect on the high aneurysmal flow volume reduction than coiling, while stenting generated adverse effect on flow reduction. Taking the NS only model as baseline (100%), the sac-averaged velocities of models II to VIII were 112%, 36%, 42%, 45%, 39%, 12%, 13%, and high flow volumes were 119%, 21%, 30%, 10%, 8%, 3%, 3%, while the sac-averaged WSSs were 106%, 37%, 44%, 41%, 35%, 17% and 24%, respectively. Conclusions Stent-induced vessel straightening combined coil embolization has the best performance in hemodynamic modifications and may reduce the recurrence rate, whereas stenting may generate adverse effect on hemodynamic alterations.