Alteration of intra-aneurysmal hemodynamics for flow diversion using enterprise and vision stents.
Alteration of intra-aneurysmal hemodynamics for flow diversion using enterprise and vision stents.
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DOI：
10.1016/j.wneu.2010.05.008
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发表时间：
2010-08
影响因子：
2
通讯作者：
Meng H
中科院分区：
文献类型：
--
作者：
Tremmel M;Xiang J;Natarajan SK;Hopkins LN;Siddiqui AH;Levy EI;Meng H
血流转移是颅内动脉瘤治疗的一个新概念。最近开发的企业血管重建装置（Codman Neurovascular, Raynham MA）提供了方便的输送和重新定位。虽然这种支架是专门为抑制动脉瘤内的线圈而设计的，但它在改变血流动力学方面有理论上的作用，目前还没有研究。本研究的目的是利用计算流体动力学（CFD）来量化单个和多个自膨胀Enterprise支架单独使用或与球囊支架联合使用对动脉瘤血流动力学的影响。从计算机断层血管造影图像重建宽颈，囊状，基底干动脉瘤的几何形状。1-3个支架的各种组合“实际上”符合血管腔并放置在动脉瘤口。对每个模型进行CFD分析，计算在动脉瘤发病和血栓形成中被认为重要的血流动力学参数。支架植入抑制了复杂的动脉瘤血流模式。支架置入降低了动脉瘤内的平均流速；通过额外的支架部署实现了进一步的降低。单支架组动脉瘤血流周转时间为114-117%，双支架组为127-128%，三支架组为141%。此外，动脉瘤壁剪切应力（WSS）随着部署支架数量的增加而降低。这是第一个分析动脉瘤闭塞置入Enterprise支架后血流改变的研究。放置2-3个支架可显著降低动脉瘤内血流动力学活动，从而增加诱发动脉瘤血栓闭塞的可能性。
Flow diversion is a novel concept for intracranial aneurysm treatment. The recently developed Enterprise Vascular Reconstruction Device (Codman Neurovascular, Raynham MA) provides easy delivery and repositioning. Although designed specifically for restraining coils within an aneurysm, this stent has theoretical effects on modifying flow dynamics, which have not been studied. The goal of this study was to quantify the effect of single and multiple self-expanding Enterprise stents alone or in combination with balloon-mounted stents on aneurysm hemodynamics using computational fluid dynamics (CFD). The geometry of a wide-necked, saccular, basilar trunk aneurysm was reconstructed from computed tomographic angiography images. Various combinations of 1–3 stents were “virtually” conformed to fit into the vessel lumen and placed across the aneurysm orifice. CFD analysis was performed to calculate hemodynamic parameters considered important in aneurysm pathogenesis and thrombosis for each model. The complex aneurysmal flow pattern was suppressed by stenting. Stent placement lowered average flow velocity in the aneurysm; further reduction was achieved by additional stent deployment. Aneurysmal flow turnover time, an indicator of stasis, was increased to 114-117% for single-stent, 127-128% for double-stent, and 141% for triple-stent deployment. Furthermore, aneurysmal wall shear stress (WSS) decreased with increasing number of deployed stents. This is the first study analyzing flow modifications associated with placement of Enterprise stents for aneurysm occlusion. Placement of 2-3 stents significantly reduced intra-aneurysmal hemodynamic activities, thereby increasing the likelihood of inducing aneurysm thrombotic occlusion.
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4.1
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