破裂微小后交通动脉动脉瘤的形状和血流动力学特点分析  

Analysis of the shape and hemodynamic characteristics of the ruptured posterior communicating artery minimal aneurysms

作　　者：张莹[1] 荆林凯 张倩倩[1] 刘健[1] 张义森[1] 穆士卿[1] 杨新健[1] 

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

出　　处：《中国脑血管病杂志》2015年第12期621-624,655,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(81301003;81371315;81171079;81220108007);首都卫生发展科研专项重点攻关项目(2014-1-1071);北京市神经外科研究所青年基金项目(2014-001)

摘　　要：目的探讨破裂微小后交通动脉动脉瘤的形状和血流动力学特点。方法回顾性收集42例微小后交通动脉动脉瘤(最大径<3mm,11例为破裂组,31例为非破裂组)患者的临床资料。对动脉瘤三维DSA形状进行评价,并根据计算机模拟模型计算流体力学参数。对比破裂组和未破裂组患者的动脉瘤形状和血流动力学参数。结果(1)未破裂组比破裂组多发动脉瘤更常见[58.1%(18/31)比9.1%(1/11),差异有统计学意义(P=0.006);(2)破裂组动脉瘤复杂流场模式和变化流场模式比率高于未破裂组[63.6%(7/11)比6.5%(2/31),P<0.01;45.5%(5/11)比3.2%(1/31),P=0.003];(3)破裂组动脉瘤壁面切应力中位数(P_(25),P_(75))为0.74(0.52,0.86),未破裂组为1.03(0.83,3.64),两组差异有统计学意义(P=0.008)。结论未破裂微小动脉瘤多见于多发动脉瘤的患者。对壁面切应力低和流场复杂且变化的微小后交通动脉动脉瘤宜积极手术干预。Objective To investigate the shape and hemodynamic characteristics of the ruptured posterior communicating artery minimal aneurysms. Methods The clinical data of 42 patients with ruptured posterior communicating artery minimal aneurysm （the maximum diameter 〈 3 mm,11 ruptured aneurysms and 31 unruptured aneurysms）were collected retrospectively. Three-dimensional DSA shapes of the aneurysms were assessed,and the hemodynamic parameters of the aneurysms were calculated according to their computer simulation models. Results （1）The multiple aneurysms were more common in the unruptured group than those in the ruptured group （58. 1% [18/ 31]vs. 9. 1% [1/ 11]）. There was significant difference,P = 0. 006 ）. （2 ）The complex flow pattern was more common in the ruptured group （63. 6%[7 / 11]vs. 6. 5% [2 / 31],P 〈 0. 01）and also the changed flow pattern （45. 5% [5 / 11]vs. 3. 2% [1 / 31）,P = 0. 003）. （3）The median aneurysm wall shear stress of the ruptured group was 0. 74 （0. 52,0. 86）and that of the unruptured group was 1. 03（0. 83,3. 64）. There was significant difference between the 2 groups （P =0. 008）. Conclusion The unruptured minimal aneurysms are common in patients with multiple aneurysms. Active surgical intervention is recommended for the posterior communicating artery minimal aneurysms with low wall shear stress,complex and change flow.

关 键 词：颅内动脉瘤 后交通动脉微小动脉瘤 血流动力学 

分 类 号：R743[医药卫生—神经病学与精神病学]