颈动脉支架成形术后支架内再狭窄的血流动力学分析  

Hemodynamic analysis of in-stent restenosis after carotid artery angioplasty and stenting

作　　者：杨凯 万林枫 陈莉 史伟浩 谭晋韵 宗原[3] 余波 Yang Kai;Wan Linfeng;Chen Li;Shi Weihao;Tan Jinyun;Zong Yuan;Yu Bo(Department of General Surgery,Shanghai Pudong Hospital,Fudan University Pudong Medical Center,Shanghai 201399,China;Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling,Shanghai 201399,China;State Key Laboratory of Chemical Engineering,East China University of Science and Technology,Shanghai 200237,China;Department of Ultrasound Medicine,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of General Surgery,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属浦东医院(上海市浦东医院)血管外科,上海201399 [2]上海市血管病变调控与重塑重点实验室,上海201399 [3]华东理工大学化学工程联合国家重点实验室,上海200237 [4]复旦大学附属华山医院超声科,上海200040 [5]复旦大学附属华山医院血管外科,上海200040

出　　处：《中华血管外科杂志》2022年第2期122-131,共10页Chinese Journal of Vascular Surgery

基　　金：浦东卫生系统学科建设资助项目(PWZy2020-13);浦东新区临床高原学科(PWYgy-2018-08);上海市医学重点专科(ZK2019A10)。

摘　　要：目的比较支架内再狭窄(ISR)与未发生支架内再狭窄(NISR)患者的血流动力学差异,判断"壁面剪切应力变化度(CDWSS)"对ISR的预测价值。方法本研究筛选得到发生ISR患者8例,并按1∶2配比NISR患者16例。随机从两组中各选择4例患者,对其术前、术后即刻及随访的颈动脉CTA进行三维重建并开展血流动力学分析,比较两组血流动力学参数差异。引入特殊点位上"CDWSS"概念,以术前CTA所对应的壁面剪切应力(WSS)为基准,对比术后即刻及随访的CDWSS数据。结果与NISR相比,ISR在分叉处及最狭窄部位的WSS高值区域扩大,且整个心动周期中数值波动幅度大。NISR组中振荡剪切指数(OSI)的数值下降,相反,在ISR组中OSI数值有所增加。高OSI区域与低WSS值区域重合度较高。随访模型中,在最狭窄部位两组CDWSS差异具有统计学意义(P=0.029)。结论相比于NISR患者,ISR患者的病灶在局部存在血流动力学差异。CDWSS对局部发生ISR与否可能具有预测价值。Objective To compare the hemodynamic differences between in-stent restenosis(ISR)and no in-stent restenosis(NISR)patients,and to judge the predictive value of"change degree wall shear stress(CDWSS)"for ISR.Methods Patients were divided into the ISR group and the NISR group.And 8 patients in the ISR group and 16 patients in the NISR group were obtained through screening and comparison of basic conditions.Four patients were randomly selected from each of the two groups,and performed three-dimensional reconstruction of their carotid artery CTA before the operation,after the operation immediately,and follow-up.Hemodynamic analysis was performed to compare the differences in hemodynamic parameters between the two groups.In addition,the concept of"CDWSS at special points"was introduced,and the wall shear stress(WSS)corresponding to the preoperative CTA was set as the benchmark to compare the postoperative and follow-up CDWSS data.Results Compared with NISR,ISR expanded in the high WSS area of bifurcation and the narrowest area,and fluctuated greatly throughout the cardiac cycle.value of oscillatory shear index(OSI)decreased in the NISR group,but increased in the ISR group.The high OSI area and the low WSS area had a higher degree of overlap.In the follow-up model,there was a statistically significant difference in the CDWSS between the two groups at the narrowest part.Conclusion There are local hemodynamic differences in the lesions of ISR patients.The CDWSS might have predictive value for the local occurrence of ISR.

关 键 词：颈动脉狭窄 支架内狭窄 血流动力学 壁面剪切应力 振荡剪切指数 

分 类 号：R651.12[医药卫生—外科学]