A proposed parent vessel geometry-based categorization of saccular intracranial aneurysms: computational flow dynamics analysis of the risk factors for lesion rupture
A proposed parent vessel geometry-based categorization of saccular intracranial aneurysms: computational flow dynamics analysis of the risk factors for lesion rupture
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DOI：
10.3171/jns.2005.103.4.0662
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发表时间：
2005-10-01
影响因子：
4.1
通讯作者：
Takahashi, A
中科院分区：
文献类型：
--
作者：
Hassan, T;Timofeev, EV;Takahashi, A
Object.作者根据载瘤动脉的血管造影记录模式，将囊状颅内动脉瘤简单、广泛适用地分为三类：侧壁（SW）、具有分支血管的侧壁（SWBV）和端壁（EW）。使用代表三种动脉瘤类别的简单模型的计算流体动力学分析（CFDA），作者分析了几何形状相关的风险因素，如瘤颈宽度、载瘤动脉曲率和分支血管成角。作者对45例破裂和23例未破裂病变患者的血管造影片上记录的68个囊性几何结构进行了CFDA。在成功研究的CFDA病例中，检查了壁面剪切应力、血流速度和压力图，并将其与动脉瘤破裂点相关联。对动脉瘤破裂病例的统计分析显示，动脉瘤深度与瘤颈大小（p <0.0001）和引流血管口径（p < 0.0001）之间存在统计学显著相关性。发现较小颈动脉瘤或具有较小口径引流血管的动脉瘤为低流量病变，易于在较小尺寸下破裂。SW和SWBV类别中破裂动脉瘤的纵横比（深度/瘤颈）超过1.6的发生率为100%，而EW动脉瘤的发生率仅为28.75%。标准化分类的应用使得能够比较各种动脉瘤的结果。几何形状，从而帮助他们的管理。提出的分类系统可能提供一个有前途的手段，了解囊状颅内动脉瘤的自然史。
Object. The authors created a simple, broadly applicable classification of saccular intracranial aneurysms into three categories: sidewall (SW), sidewall with branching vessel (SWBV), and endwall (EW) according to the angiographically documented patterns of their parent arteries. Using computational flow dynamics analysis (CFDA) of simple models representing the three aneurysm categories, the authors analyzed geometry-related risk factors such as neck width, parent artery curvature, and angulation of the branching vessels.Methods. The authors performed CFDAs of 68 aneurysmal geometric formations documented on angiograms that had been obtained in patients with 45 ruptured and 23 unruptured lesions. In successfully studied CFDA cases, the wall shear stress, blood velocity, and pressure maps were examined and correlated with aneurysm rupture points. Statistical analysis of the cases involving aneurysm rupture revealed a statistically significant correlation between aneurysm depth and both neck size (p < 0.0001) and caliber of draining arteries (p < 0.0001).Wider-necked aneurysms or those with wider-caliber draining vessels were found to be high-flow lesions that tended to rupture at larger sizes. Smaller-necked aneurysms or those with smaller-caliber draining vessels were found to be low-flow lesions that tended to rupture at smaller sizes. The incidence of ruptured aneurysms with an aspect ratio (depth/neck) exceeding 1.6 was 100% in the SW and SWBV categories, whereas the incidence was only 28.75% for the EW aneurysms.Conclusions. The application of standardized categories enables the comparison of results for various aneurysms. geometric formations, thus assisting in their management. The proposed classification system may provide a promising means of understanding the natural history of saccular intracranial aneurysms.