Hemodynamic conditions that favor bleb formation in cerebral aneurysms.
Hemodynamic conditions that favor bleb formation in cerebral aneurysms.
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DOI：
10.1136/neurintsurg-2020-016369
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发表时间：
2021-03
影响因子：
4.8
通讯作者：
Cebral JR
中科院分区：
文献类型：
--
作者：
Salimi Ashkezari SF;Mut F;Chung BJ;Robertson AM;Cebral JR
尽管人们普遍认为，气泡代表颅内动脉瘤（IAs）壁上的薄弱点，但哪些动脉瘤特征有利于它们的发展在很大程度上是未知的。选取199例患者的270例IAs进行手术夹持研究。在术前图像构建的患者特异性血管模型上，对气泡进行视觉识别和交互式标记。然后从血管重建中删除气泡，以在气泡形成之前接近动脉瘤。在这些模型以及没有气泡的情况下进行了计算流体动力学研究。比较有和无气泡动脉瘤的血流动力学和几何特征。173个动脉瘤无气泡，97个动脉瘤有122个气泡。与无气泡的动脉瘤相比，有利于气泡形成的动脉瘤具有更强（p<0.0001）和更集中的流入射流（p<0.0001），更高的流速（p=0.0061），更复杂（p<0.0001）和不稳定（p=0.0157）的流型，更大的最大壁面剪切应力（WSS） （p<0.0001），更集中（p=0.0005）和振荡（p=0.0004）的WSS分布，以及更不均匀的WSS场（p<0.0001）。它们也更大（p<0.0001），更细长（p<0.0001），脖子更宽（p=0.0002），形状更扭曲和不规则（p<0.0001）。强而集中的流入射流、高速、复杂而不稳定的流型以及集中、振荡和非均匀的WSS流型有利于IAs中气泡的形成。大的、细长的、形状不规则的动脉瘤更容易形成水泡。当评估动脉瘤是否需要保守观察或治疗时，这些不良特征可被视为动脉瘤不稳定的迹象。
Although it is generally believed that blebs represent weaker spots in the walls of intracranial aneurysms (IAs), it is largely unknown which aneurysm characteristics favor their development. A total of 270 IAs in 199 patients selected for surgical clipping were studied. Blebs were visually identified and interactively marked on patient-specific vascular models constructed from pre-surgical images. Blebs were then deleted from the vascular reconstruction to approximate the aneurysm before bleb formation. Computational fluid dynamics studies were performed in these models as well as cases without blebs. Hemodynamic and geometric characteristics of aneurysms with and without blebs were compared. A total of 173 aneurysms had no blebs, while 97 aneurysms had a total of 122 blebs. Aneurysms favoring bleb formation had stronger (p<0.0001) and more concentrated inflow jets (p<0.0001), higher flow velocity (p=0.0061), more complex (p<0.0001) and unstable (p=0.0157) flow patterns, larger maximum wall shear stress (WSS) (p<0.0001), more concentrated (p=0.0005) and oscillatory (p=0.0004) WSS distribution, and a more heterogeneous WSS field (p<0.0001), than aneurysms without blebs. They were also larger (p<0.0001), more elongated (p<0.0001), had wider necks (p=0.0002), and more distorted and irregular shapes (p<0.0001). Strong and concentrated inflow jets, high speed, complex and unstable flow patterns, and concentrated, oscillatory, and heterogeneous WSS patterns favor the formation of blebs in IAs. Blebs are more likely to form in large, elongated, and irregularly shaped aneurysms. These adverse characteristics could be considered signs of aneurysm instability when evaluating aneurysms for conservative observation or treatment.
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影响因子：
3.2
作者：
Durka MJ;Wong IH;Kallmes DF;Pasalic D;Mut F;Jagani M;Blanco PJ;Cebral JR;Robertson AM
通讯作者：
Robertson AM
DOI：
10.3174/ajnr.a4358
发表时间：
2015-09
期刊：
AJNR. American journal of neuroradiology
影响因子：
--
作者：
Cebral JR;Duan X;Chung BJ;Putman C;Aziz K;Robertson AM
通讯作者：
Robertson AM
影响因子：
8.3
作者：
Shojima, M;Oshima, M;Kirino, T
通讯作者：
Kirino, T
影响因子：
8.3
作者：
Lindgren, Antti E.;Koivisto, Timo;Frosen, Juhana
通讯作者：
Frosen, Juhana
影响因子：
10.6
作者：
Cebral, JR;Castro, MA;Frangi, AF
通讯作者：
Frangi, AF