Effect of hemodynamics on outcome of subtotally occluded paraclinoid aneurysms after stent-assisted coil embolization.
Effect of hemodynamics on outcome of subtotally occluded paraclinoid aneurysms after stent-assisted coil embolization.
复制标题
血流动力学对支架辅助弹簧圈栓塞后次全闭塞床突旁动脉瘤结局的影响。
DOI：
10.1136/neurintsurg-2015-012050
复制
发表时间：
2016-11
影响因子：
4.8
通讯作者：
Yang X
中科院分区：
文献类型：
--
作者：
Liu J;Jing L;Wang C;Paliwal N;Wang S;Zhang Y;Xiang J;Siddiqui AH;Meng H;Yang X
临床上首选血管内治疗床旁动脉瘤。支架和弹簧圈引起的血流改变可能会影响治疗结果。我们的目的是评估支架辅助弹簧圈栓塞术治疗残留颈椎易再通的次完全栓塞型床旁动脉瘤后的血流动力学变化。我们研究了27个床旁动脉瘤(7个再通，20个稳定)，用弹簧圈和企业™支架治疗。使用虚拟支架和多孔介质技术对患者特定的动脉瘤几何形状进行计算流体动力学模拟。27例支架置入后，动脉瘤血流速度明显降低，从颈平面(11.9%)到残颈(12.3%)，再到动脉瘤穹隆(16.3%)。支架置入后进行弹簧圈栓塞术，除颈平面外，所有动脉瘤部位的血流动力学指标均进一步明显降低。单因素分析显示，再通组与稳定组治疗前各指标均无显著差异。支架置入后，血管再通组(8.1%)和稳定组(20.5%)之间仅颈平面平均血流速度下降有显著差异(p=0.016)。支架置入和弹簧圈栓塞术可显著降低动脉瘤血流速度。然而，动脉瘤颈平面的血流动力学对弹簧圈的敏感性较低。颈平面血流速度的显著降低可能是支架辅助弹簧圈栓塞术后防止床旁动脉瘤再通的一个重要因素。
Endovascular treatment of paraclinoid aneurysms is preferred in clinical practice. Flow alterations caused by stents and coils may affect treatment outcome. Our aim was to assess hemodynamic changes following stent-assisted coil embolization in subtotally embolized paraclinoid aneurysms with residual necks that were predisposed to recanalization. We studied 27 paraclinoid aneurysms (seven recanalized and 20 stable) treated with coils and Enterprise™ stents. Computational fluid dynamics simulations were performed on patient-specific aneurysm geometries using virtual stenting and porous media technology. After stent placement in 27 cases, aneurysm flow velocity decreased significantly, gradually increasing from the neck plane (11.9%), to the residual neck (12.3%), to the aneurysm dome (16.3%). Subsequent coil embolization was performed after stent placement and the hemodynamic factors decreased further and significantly at all aneurysm regions except the neck plane. Compared between recanalized and stable cases, univariate analysis showed no significant differences in any parameter before treatment. After stent-assisted coiling, only the reduction in area-averaged velocity at the neck plane differed significantly between recanalized (8.1%) and stable cases (20.5%) (p=0.016). Aneurysm flow velocity can be significantly decreased by stent placement and coil embolization. However, hemodynamics at the aneurysm neck plane was less sensitive to coils. Significant reduction in flow velocity at the neck plane may be an important factor in preventing recanalization of paraclinoid aneurysms after subtotal stent-assisted coil embolization.