Computational fluid dynamics modeling of symptomatic intracranial atherosclerosis may predict risk of stroke recurrence.
Computational fluid dynamics modeling of symptomatic intracranial atherosclerosis may predict risk of stroke recurrence.
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DOI：
10.1371/journal.pone.0097531
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Wong KS
中科院分区：
文献类型：
--
作者：
Leng X;Scalzo F;Ip HL;Johnson M;Fong AK;Fan FS;Chen X;Soo YO;Miao Z;Liu L;Feldmann E;Leung TW;Liebeskind DS;Wong KS
有症状的颅内动脉粥样硬化（ICAS）管腔狭窄≥70%的患者卒中复发风险较高。我们的目的是评估计算流体动力学（CFD）模型揭示的ICAS血流动力学与该患者亚组卒中复发风险之间的关系。筛选了70-99%管腔狭窄的症状性ICAS病变患者并入组本研究。基于基线计算机断层扫描血管造影（CTA）源图像重建CFD模型，以显示符合条件的症状性ICAS病变的血流动力学。狭窄前后压力的比值代表病变的压力变化。狭窄段和近端正常血管段剪切应变率（SSR）的比值代表病变处剪切应变率（SSR）的变化，流速的变化类似。随访1年。总体而言，招募了32例患者（中位年龄65岁; 59.4%为男性）。ICAS病变的中位压力、SSR和流速比分别为0.40（−2.46-0.79）、4.5（2.2-20.6）和7.4（5.2-12.5）。单变量考克斯回归分析显示SSR比值（风险比[HR] 1.027; 95%可信区间[CI]，1.004-1.051; P = 0.023）和流速比（HR 1.029; 95% CI，1.002-1.056; P =0.035）与1年内复发的局部缺血性卒中显著相关，受试者操作特征分析的c统计量分别为0.776（95% CI，0.594-0.903; P =0.014）和0.776（95% CI，0.594-0.903; P=0.002）。 根据常规获得的CTA图像重建的CFD模型上的ICAS血流动力学可以预测具有70-99%管腔狭窄的症状性ICAS病变的患者随后的卒中复发。
Patients with symptomatic intracranial atherosclerosis (ICAS) of ≥70% luminal stenosis are at high risk of stroke recurrence. We aimed to evaluate the relationships between hemodynamics of ICAS revealed by computational fluid dynamics (CFD) models and risk of stroke recurrence in this patient subset. Patients with a symptomatic ICAS lesion of 70–99% luminal stenosis were screened and enrolled in this study. CFD models were reconstructed based on baseline computed tomographic angiography (CTA) source images, to reveal hemodynamics of the qualifying symptomatic ICAS lesions. Change of pressures across a lesion was represented by the ratio of post- and pre-stenotic pressures. Change of shear strain rates (SSR) across a lesion was represented by the ratio of SSRs at the stenotic throat and proximal normal vessel segment, similar for the change of flow velocities. Patients were followed up for 1 year. Overall, 32 patients (median age 65; 59.4% males) were recruited. The median pressure, SSR and velocity ratios for the ICAS lesions were 0.40 (−2.46–0.79), 4.5 (2.2–20.6), and 7.4 (5.2–12.5), respectively. SSR ratio (hazard ratio [HR] 1.027; 95% confidence interval [CI], 1.004–1.051; P = 0.023) and velocity ratio (HR 1.029; 95% CI, 1.002–1.056; P = 0.035) were significantly related to recurrent territorial ischemic stroke within 1 year by univariate Cox regression, respectively with the c-statistics of 0.776 (95% CI, 0.594–0.903; P = 0.014) and 0.776 (95% CI, 0.594–0.903; P = 0.002) in receiver operating characteristic analysis. Hemodynamics of ICAS on CFD models reconstructed from routinely obtained CTA images may predict subsequent stroke recurrence in patients with a symptomatic ICAS lesion of 70–99% luminal stenosis.
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