Angioarchitectures and Hemodynamic Characteristics of Posterior Communicating Artery Aneurysms and Their Association with Rupture Status.
Angioarchitectures and Hemodynamic Characteristics of Posterior Communicating Artery Aneurysms and Their Association with Rupture Status.
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DOI：
10.3174/ajnr.a5358
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发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Cebral JR
中科院分区：
文献类型：
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作者：
Chung BJ;Doddasomayajula R;Mut F;Detmer F;Pritz MB;Hamzei-Sichani F;Brinjikji W;Kallmes DF;Jimenez CM;Putman CM;Cebral JR
与其他部位相比，起源于后交通动脉(PCOM)的颅内动脉瘤具有较高的破裂风险。我们验证了这样一种假设，即不同的PCOM动脉瘤的血管构筑(即分支点结构)与动脉瘤的血流动力学有关，而这反过来又容易导致动脉瘤破裂。对313个PCOM动脉瘤(145个破裂，168个未破裂)进行了基于图像的计算流体动力学(CFD)研究。根据动脉瘤相对于载瘤动脉分叉的位置，将动脉瘤分为不同的血管构筑类型。比较破裂动脉瘤与未破裂动脉瘤以及不同血管构筑的动脉瘤的血流动力学特征。血管构筑与破裂相关(p=0.0033)。与未破裂的动脉瘤相比，破裂的动脉瘤具有更高、更集中和更振荡的壁切应力分布(WSSmax，p<；0.0001；SCI，p=0.0001；OSI，p<；0.0001)，更强和更集中的流入射流(q，p=0.01；ICI，p=0.0002)，以及更复杂和不稳定的血流模式(CORELEN，p<；0.0001；PODENT，p=0.0008)。与侧壁或侧壁血管构筑的动脉瘤相比，这些不良情况在具有分叉型血管构筑的动脉瘤中更为常见。有趣的是，破裂动脉瘤的标准化平均WSS(WSSNorm，p=0.0182)和最小WSSmin(WSSmin，p=0.0017)也低于未破裂动脉瘤。在分叉型血管结构中常见的高流量球囊内血流动力学特征与PCOM动脉瘤破裂状态有关。这些特征包括强而集中的入流急流、升高的WSS集中区、振荡WSS、低归一化WSS和复杂的不稳定流型。
Intracranial aneurysms at the posterior communicating artery (PCOM) origin are known to have high rupture risk compared to other locations. We tested the hypothesis that different angio-architectures (i.e. branch point configuration) of PCOM aneurysms associated with aneurysm hemodynamics which in turn predisposes aneurysms to rupture. A total of 313 PCOM aneurysms (145 ruptured, 168 unruptured) were studied with image-based computational fluid dynamics (CFD). Aneurysms were classified into different angio-architecture types depending on the location of the aneurysm with respect to parent artery bifurcation. Hemodynamic characteristics were compared between ruptured and unruptured aneurysms, as well as among aneurysms with different angio-architectures. Angio-architecture was associated with rupture (p=0.0033). Ruptured aneurysms had higher, more concentrated and more oscillatory wall shear stress distributions (WSSmax, p<0.0001; SCI, p=0.0001; OSImean, p<0.0001), stronger and more concentrated inflow jets (Q, p=0.01; ICI, p=0.0002), and more complex and unstable flow patterns (CORELEN, p<0.0001; PODENT, p=0.0008) as compared to unruptured aneurysms. These adverse conditions were more common in aneurysms with bifurcation-type angio-architectures, compared to those with lateral or sidewall angio-architectures. Interestingly, ruptured aneurysms also had lower normalized mean WSS (WSSnorm, p=0.0182) and minimum WSS (WSSmin, p=0.0017) than unruptured aneurysms. High-flow intra-saccular hemodynamic characteristics, commonly found in bifurcation-type angio-architectures, are associated with PCOM aneurysm rupture status. These characteristics include strong and concentrated inflow jets, concentrated regions of elevated WSS, oscillatory WSS, lower normalized WSS, and complex unstable flow patterns.