Hemodynamic Risk Factors for the Development of Carotid Stenosis in Patients with Unilateral Carotid Stenosis
Hemodynamic Risk Factors for the Development of Carotid Stenosis in Patients with Unilateral Carotid Stenosis
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DOI：
10.1016/j.wneu.2022.01.019
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发表时间：
2022-03-28
影响因子：
2
通讯作者：
Tsukahara, Tetsuya
中科院分区：
文献类型：
--
作者：
Fukuda, Shunichi;Shimogonya, Yuji;Tsukahara, Tetsuya
背景：通过已知的危险因素很难预测颈动脉狭窄的发展。使用计算流体动力学分析，我们研究了颈动脉狭窄的血流动力学风险，专注于壁面切应力（WSS）disturbances.METHODS：在59例单侧颈动脉狭窄，斑块被删除，从原来的三维计算机断层扫描血管造影图像，和狭窄前的血管形状被人工复制。进行多变量回归分析，以确定调整后的6个已知的风险factors.RESULTS：WSS干扰的程度之间的关联区域狭窄和血流动力学和形态学因素较高，和远端的分叉处的颈动脉斑块去除后，与正常的颈动脉相比，WSS的幅度和指标较低。在斑块清除动脉中，狭窄程度与WSS紊乱的狭窄与远端度量值的比率以及颈外动脉与颈总动脉的直径比率呈显著负相关，与WSS幅度的近端与狭窄度量值的比率呈正相关。从颈总动脉到分叉处WSS快速增加，从分叉处到颈内动脉WSS干扰快速减少，颈外动脉与颈总动脉直径比值较低者较其他危险因素更易导致严重狭窄。对于存在这些血流动力学风险的患者，应更严格地控制基础疾病，缩短影像学检查间隔。
BACKGROUND: It is difficult to predict the development of carotid stenosis by means of the known risk factors. Using a computational fluid dynamics analysis, we examined the hemodynamic risks for carotid stenosis, focusing on wall shear stress (WSS) disturbances.METHODS: In 59 patients with unilateral carotid stenosis, the plaque was removed from the original three-dimensional computed tomography angiographic images, and the vessel shape before stenosis was artificially reproduced. A multivariate regression analysis was performed to determine the associations between the degree of area stenosis and hemodynamic and morphologic factors after adjustment for 6 known risk factors.RESULTS: Metrics for WSS disturbances were higher at and distal to a bifurcation in the carotid arteries after plaque removal compared with the normal carotid arteries, and metrics for WSS magnitudes were lower. In the plaque-removed arteries, the degree of stenosis was significantly negatively correlated with the ratio of stenotic to distal values of metrics for WSS disturbances and the diameter ratio of the external to common carotid artery, and positively correlated with the ratio of proximal to stenotic values of metrics for WSS magnitudes.CONCLUSIONS: Rapid increases in WSS from the common carotid artery toward the bifurcation, rapid decreases in WSS disturbance from the bifurcation toward the internal carotid artery, and lower diameter ratio of the external to common carotid artery are more likely than other risk factors to cause future severe stenosis. In patients with these hemodynamic risks, underlying diseases should be controlled more strictly, with imaging examinations at shorter intervals.