Aneurysm Rupture Following Treatment with Flow-Diverting Stents: Computational Hemodynamics Analysis of Treatment
Aneurysm Rupture Following Treatment with Flow-Diverting Stents: Computational Hemodynamics Analysis of Treatment
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DOI：
10.3174/ajnr.a2398
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发表时间：
2011-01-01
影响因子：
3.5
通讯作者：
Putman, C. M.
中科院分区：
文献类型：
--
作者：
Cebral, J. R.;Mut, F.;Putman, C. M.
背景和目的：颅内动脉瘤治疗的血流导向方法有许多有希望的早期结果，但最近明显成功的治疗因后期动脉瘤出血而复杂化。我们分析了7例动脉瘤与血流导向治疗，探讨可能的破裂mechanism.MATERIALS和METHODS：CFD分析的前和治疗后的条件进行了3个巨大的动脉瘤，治疗后破裂和4个成功治疗的动脉瘤。治疗前和治疗后的血流动力学进行了比较，包括WSS，相对血流量，血管阻力和压力，以确定血流导向装置places.Results的影响：预期的减少动脉瘤的速度和WSS，表明有效的流量从囊转移到载瘤动脉，与围手术期观察一致。在每例动脉瘤后破裂的病例中，血流转向的结果导致动脉瘤内压力增加。这种压力增加与载瘤动脉放置装置产生的更大有效阻力有关，并且在2例病例中，减少了动脉瘤前狭窄。结论：血流导向装置可导致动脉瘤内压力增加，这可能会导致动脉瘤内压力增加，这可能会导致破裂，尤其是对于巨大动脉瘤。与载瘤动脉构型的变化（例如近端狭窄的减少）和与脑自动调节相结合的进入更高阻力载瘤动脉通路的血流转向（导致更高的压力梯度）有关。这些可能是规划干预措施时应考虑的重要影响。可以通过血管造影和/或患者特定CFD模型识别潜在危险病例。
BACKGROUND AND PURPOSE: Flow-diverting approaches to intracranial aneurysm treatment had many promising early results, but recent apparently successful treatments have been complicated by later aneurysm hemorrhage. We analyzed 7 cases of aneurysms treated with flow diversion to explore the possible rupture mechanisms.MATERIALS AND METHODS: CFD analysis of pre- and posttreatment conditions was performed on 3 giant aneurysms that ruptured after treatment and 4 successfully treated aneurysms. Pre- and posttreatment hemodynamics were compared including WSS, relative blood flows, vascular resistances, and pressures, to identify the effects of flow-diverter placements.RESULTS: Expected reductions in aneurysm velocity and WSS were obtained, indicating effective flow diversion from the sac into the parent artery, consistent with periprocedural observations. In each case with postaneurysm rupture, the result of flow diversion led to an increase in pressure within the aneurysm. This pressure increase is related to larger effective resistance in the parent artery from placement of the devices and, in 2 cases, the reduction of a preaneurysm stenosis.CONCLUSIONS: Flow-diversion devices can cause intra-aneurysmal pressure increases, which can potentially lead to rupture, especially for giant aneurysms. relates both to changes in the parent artery configuration, such as reduction of a proximal stenosis, and to the flow diversion into higher resistance parent artery pathways combined with cerebral autoregulation, leading to higher pressure gradients. These may be important effects that should be considered when planning interventions. Potentially dangerous cases could be identified with angiography and/or patient-specific CFD models.