支架置入治疗大脑中动脉瘤的数值模拟研究  

Numerical simulation study of stenting in the treatment of middle cerebral artery aneurysms

作　　者：卢海涛[1] 黄清海[1] 杨鹏飞[1] 刘建民[1] 陈家亮[2] 王盛章[2] 

机构地区：[1]第二军医大学上海长海医院神经外科,200433 [2]复旦大学力学与工程科学系

出　　处：《中国脑血管病杂志》2009年第12期651-655,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：上海市自然科学基金资助项目(08ZR1404200);上海市优秀学科带头人项目(07XD14026);上海市科委重点项目基金资助项目(074119506)

摘　　要：目的探讨支架置入前、后,计算机数值模拟大脑中动脉分叉处动脉瘤的血流动力学变化。方法结合DSA影像,采用计算流体力学有限元方法的软件,对单纯使用支架治疗大脑中动脉分叉处未破裂动脉瘤的1例患者,在支架置入前及支架置入后9个月,行血管形态学特征和血流动力学数值模拟分析(包括血液流线、血管壁面压力和剪应力等)。从三维旋转造影图像数据中获得模型,将生理脉动流作为进入流,采用软件生成网格并计算非定常层流的连续动力方程。结果与支架置入前比较,支架置入后,①血管形态学发生了明显改变,大脑中动脉的M1段和M2段下干血管夹角变大(67.7°变为124.1°),瘤体消失。②血流对瘤颈口冲击明显降低,改变动脉瘤内的压力,术前瘤顶平均壁面压力为977.06Pa,瘤颈处平均壁面压力为950.46Pa。支架置入后消除了瘤颈处的高壁面压力区域,9个月时复查该处平均壁面压力为831.31Pa。③改善动脉瘤表面的壁面切应力(WSS)分布,术前瘤顶区域的平均WSS为2.09Pa,瘤颈区域的平均WSS为7.51Pa,9个月复查时变得渐趋一致。结论血管内单纯支架置入通过对血管形态学的改变,引起血流动力学变化可能是使动脉瘤愈合的机制。Objective To investigate the hemodynamic changes of the aneurysm at the bifurcation of middle cerebral artery before and after stent implantation. Methods A patient with unruptured aneurysm at the bifurcation of middle cerebral artery was treated with simple stent implantation, finite element software for computation of fluid dynamics in combination with the digital subtraction angiography （DSA） were used during stenting. The vascular morphological characteristics and the analysis of hemodynamic numerical simulation （including blood streamline, vascular wall pressure and shear stress, etc ） were performed before and 9 months after the stent implantation. The model was obtained from three-dimensional rotational angiography image data, and the physiological pulsatile flow was used as inflow blood flow, software was used to generate grids, and the continuous dynamic equations of the unsteady laminar flow were calculated. Results ①The vascular morphology changed significantly after stent implantation, the angle between the M1 segment of middle cerebral artery and under the branch of M2 were enlarged （from 67.7° to 124.1 °） , and the aneurysm disappeared. ②The impact of blood flow on the neck of aneurysm was reduced signifi- cantly. It changed the intra-aneurysmal pressure within the time window （the preoperative average wall pressures at the top and the neck of the aneurysm were 977.06 Pa and 950.46 Pa, respectively）. Stent implantation eliminated the high-wall pressure region around the neck of aneurysm, and the average wall pressure reexamined at the same area was 831.31 Pa at 9 months after stenting. （~）Atter improving the distribu- tion of wall shear stress （WSS） on the surface of the aneurysm, the preoperative average wall pressures at the top and at the neck of the aneurysm were 2.09 Pa and 7.51 Pa, respectively. They became increasingly con- sistent during the reexamination. Conclusion Simple endovascular stent implantation may cause hemody- namic change through the change of vasc

关 键 词：颅内动脉瘤 血流动力学 计算机模拟 计算流体力学 

分 类 号：R743.3[医药卫生—神经病学与精神病学]