颅内后交通动脉动脉瘤栓塞后复发的血流动力学数值模拟分析  

Hemodynamic numerical simulation of recurrent posterior communicating artery aneurysms after embolization

作　　者：刘爱华[1] 李传辉[1] 杨新健[1] 罗斌[2] 吴中学[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经介入科北京市神经外科研究所,北京100050 [2]清华大学玉泉医院神经外科

出　　处：《中国脑血管病杂志》2013年第2期60-65,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金项目(30901557;81220108007;81171079);"十二五"国家科技支撑计划(2011BAI08B00);北京市卫生系统高层次卫生技术人才培养计划(2009-3-22;2011-3-036);北京市科技新星计划(2007A043)

摘　　要：目的采用血流动力学数值模拟的方法探讨颅内后交通动脉动脉瘤(PCoA-An)栓塞前后的血流动力学特点及其对栓塞术后复发的影响。方法连续纳入2008年1月—2010年2月行栓塞治疗的PCoA-An患者13例,根据随访的结果将其分为复发组4例和稳定组9例。基于栓塞前后的三维脑血管造影资料建立动脉瘤模型,通过计算流体力学软件,采用有限元算法对术前及术后瘤颈区域的血流动力学特征进行分析,并评价其对动脉瘤复发(2～18个月)的影响。结果栓塞术前,复发组瘤颈区域的收缩峰期壁面切应力(WSS)和血流速度分别为(29±7)Pa和(0.62±0.12)m/s,稳定组分别为(31±12)Pa和(0.85±0.29)m/s,两组比较差异均无统计学意义,P>0.05。栓塞术后,复发组相同区域收缩峰期的WSS和血流速度分别为(48±4)Pa和(0.99±0.09)m/s,与术前比较均明显增高,P<0.05;稳定组分别为(21±12)Pa和(0.57±0.27)m/s,与术前比较均明显降低,P<0.05。栓塞术后,复发组瘤颈区域收缩峰期的WSS和血流速度均明显高于稳定组,差异有统计学意义,P<0.01,P<0.05。结论栓塞PCoA-An后,瘤颈区域存在的高WSS、高血流速度可能是导致术后动脉瘤复发的重要因素。Objective To investigate the hemodynamic features before and after embolization of posterior communicating artery aneurysms using bemodynamic numerical simulation and the influence on the recurrence after embolization. Methods A total of 13 consecutive patients with posterior communicating artery aneurysms treated with embolization from January 2008 to February 2010 were enrolled in the study. They were divided into either a recurrent group （n=4） or a stable group （n=9） according to the follow-up results. An aneurysm model was induced based on three-dimensional cerebral angiography data before and after embolization. The hemodynamic features around the aneurysm neck areas before and after embolization were analyzed with the finite element algorithm via computational fluid dynamics software, and its influence on the recurrence of aneurysms was evaluated. Results The peak systolic wall shear stress （WSS） and blood flow velocity around the aneurysm neck areas in the recurrent group before embolization were 29±7 Pa and 0.62±0.12 m/s respectively, and they were 3 l±12 Pa and 0.85±0.29m/s respectively in the stable group. There were no significant differences between the 2 groups. The peak systolic WSS and blood flow velocity around the same areas in the recurrent group after embolization were 48 ＋ 4 Pa and 0.99±0.09 m/s respectively. They were significantly higher compared to those before embolization （P 〈 0.01, P 〈 0.05 ）. They were 21 ＋ 12 Pa and 0.57± 0.27 m/s respectively in the stable group. Com- pared to those before embolization, they were significantly higher （P 〈 0.01, P 〈 0.05 ）. The peak systolic WSS and blood flow velocity around the aneurysm neck areas in the recurrent group were significantly higher than those in the stable group after embolization. Conclusion The high blood flow velocity and high WSS around the aneurysm neck areas after embolization of posterior communicating artery aneurysms may be an important factor of leading to aneurysm recurrence.

关 键 词：栓塞 治疗性 血流动力学 后交通动脉动脉瘤 复发 

分 类 号：R743[医药卫生—神经病学与精神病学]