Hemodynamics in Ruptured Intracranial Aneurysms with Known Rupture Points
Hemodynamics in Ruptured Intracranial Aneurysms with Known Rupture Points
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DOI：
10.1016/j.wneu.2018.07.026
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发表时间：
2018-10-01
影响因子：
2
通讯作者：
Yang, Xinjian
中科院分区：
文献类型：
--
作者：
Li, Miao;Wang, Jie;Yang, Xinjian
背景：血流动力学在动脉瘤破裂中起重要作用。显微手术夹闭是确定破裂点的最佳方法。本研究的目的是探讨破裂点与血流动力学之间的关系。方法：对16个颅内动脉瘤进行计算流体动力学模拟。由3名独立的神经外科医生在夹闭时检测破裂点。计算破裂点和整个动脉瘤囊的血流动力学参数，包括壁面切应力（WSS）和振荡剪切指数（OSI）。结果：动脉瘤囊处的时间平均WSS为3.4855 ± 3.8881 Pa，显著大于破裂点处的WSS（1.5403 ± 2.3688 Pa，P = 0.002）。破裂点的OSI（0.0354 +/- 0.0459）大于囊（0.0220 +/- 0.0232），无差异。13个动脉瘤（81.3%）在动脉瘤囊中显示出复杂的流动模式;然而，超过三分之二的病例（68.7%）在破裂点处未显示出流动影响。在这些有子滤过泡的病例中，6例破裂点被证实在滤过泡处。两例未显示大泡和破裂点之间的相关性。结论：破裂点的血流动力学特征与动脉瘤囊不同，破裂点的WSS明显低于动脉瘤囊。目前，对断裂危险性评价的研究还需要更多的数据和详细的资料。
BACKGROUND: Hemodynamics plays an important role in aneurysm rupture. Microsurgical clipping provides the best chance to confirm the rupture point. The aim of this study was to explore the associations between the rupture point and hemodynamics.METHODS: Computational fluid dynamic simulations were performed on 16 intracranial aneurysms. The rupture point was detected at the time of clipping by 3 independent neurosurgeons. Hemodynamic parameters, including wall shear stress (WSS) and oscillatory shear index (OSI), were calculated at the rupture point and the whole aneurysm sac. Intra-aneurysmal flow patterns and flow impingement were also studied.RESULTS: The time-averaged WSS was 3.4855 +/- 3.8881 Pa at the aneurysm sac, which was significantly larger than that at the rupture point (1.5403 +/- 2.3688 Pa, P = 0.002). The OSI at the rupture point (0.0354 +/- 0.0459) was larger than at the sac (0.0220 +/- 0.0232) without difference. Thirteen aneurysms (81.3%) showed a complex flow pattern in the aneurysm sac; however, more than two thirds of the cases (68.7%) did not show a flow impact at the rupture point. Of these cases with daughter blebs, the rupture points were confirmed at the blebs in 6 cases. Two cases did not show association between blebs and rupture point.CONCLUSIONS: The hemodynamic characteristics at the rupture point were different from the aneurysm sac, and the WSS was significantly lower at the rupture point. Further study on the rupture risk assessment is still needed with more data and detailed information.