计算流体动力学模拟脑血流在大脑前动脉A1近端后方动脉瘤血管内治疗中的应用  

Application of computational fluid dynamics simulation of cerebral blood flow in endovascular treatment of proximal posterior aneurysms of anterior cerebral artery A1

作　　者：许岗勤 张坤 蔡栋阳 杨博文 赵同源 薛绛宇 李天晓 Xu Gangqin;Zhang Kun;Cai Dongyang;Yang Bowen;Zhao Tongyuan;Xue Jiangyu;Li Tianxiao(Cerebrovascular Division of Interventional Therapy Center,Zhengzhou University People′s Hospital,Cerebrovascular Disease Hospital,Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院脑血管介入治疗中心,河南省人民医院脑血管病医院,郑州450003

出　　处：《中华神经外科杂志》2022年第10期1027-1031,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81601583);国家"十三五"重点研发计划(2016YFC1300702);河南省科技攻关项目(16210231068,172102310509)。

摘　　要：目的初步探讨基于计算流体动力学(CFD)模拟脑血流流线的微导管塑形方法在大脑前动脉A1近端后方动脉瘤血管内治疗中的应用,并评价其安全性和有效性。方法回顾性分析2019年1月至2021年9月郑州大学人民医院脑血管介入治疗中心收治的8例大脑前动脉A1近端后方未破裂动脉瘤患者的临床资料。8例患者术前均行全脑三维数字减影血管造影(3D-DSA)检查,然后依据3D-DSA数据打印1∶1透明树脂动脉瘤中空模型,应用CFD模拟动脉瘤血流流线并根据流线进行微导管塑形,体外使用动脉瘤模型验证微导管塑形的准确性;然后进行手术栓塞动脉瘤,并分析术中微导管的到位情况、成功率及稳定性。术后动脉瘤的栓塞结果采用Raymond分级评估;患者术后的神经功能采用改良Rankin量表评分(mRS)评估。结果体外微导管到位验证试验显示,8例微导管均顺利到位,其稳定性良好。术中7例微导管一次性塑形顺利到位,1例动脉瘤因近端血管迂曲,行二次微导管塑形后顺利到位。所有患者术中导管头端稳定、支撑力良好,无导管脱出,均无动脉瘤破裂及手术相关并发症。术后即刻DSA显示,7例动脉瘤完全栓塞(Raymond分级Ⅰ级),1例瘤颈少量残留(Raymond分级Ⅱ级)。8例患者的随访时间为3~12个月,其中mRS 0分7例,1分1例。共6例进行了DSA随访,其中5例动脉瘤完全栓塞(Raymond分级Ⅰ级),1例瘤颈残留(Raymond分级Ⅱ级)。结论初步观察认为,基于CFD模拟脑血流流线塑形的微导管不仅到位成功率高,而且稳定、支撑力良好,可降低手术难度及风险,从而减少并发症,提高动脉瘤的栓塞效果。Objective To preliminarily explore the application of microcatheter shaping method based on CFD(computational fluid dynamics)simulation of cerebral blood flow lines in endovascular treatment of proximal posterior aneurysms of anterior cerebral artery A1 and to evaluate its safety and effectiveness.Methods A retrospective analysis was conducted on the clinical data of 8 patients with unruptured posterior anterior cerebral artery A1 aneurysms who were admitted to the Cerebrovascular Division of Interventional Therapy Center,Zhengzhou University People′s Hospital from January 2019 to September 2021.All 8 patients underwent 3D-DSA before surgery.A1∶1 transparent resin hollow aneurysm model was printed according to the 3D-DSA data,and the aneurysm blood flow lines were simulated by CFD and microcatheter shaping was performed according to the flow lines.The accuracy of microcatheter shaping was verified by aneurysm model in vitro.Then endovascular treatment was performed,the tip position,success rate and stability of the microcatheter were analyzed.The embolization results of were evaluated based on the Raymond grading system.Postoperative neurological function was assessed by modified Rankin Scale(mRS)score.Results All microcatheters were placed successfully with good stability in 8 patients,which was shown by in vitro test.Microcatheters were anchored in position for one time in 7 cases.The remaining 1 case underwent the remodeling for the second time due to vascular tortuosity and achieved good anchoring.During the operation,the catheter tip was stable in all patients with good support.No catheter prolapse,aneurysm rupture or surgical complications occurred in those patients.DSA immediately after surgery showed complete embolization of aneurysms in 7 cases(Raymond gradeⅠ)and minimal residual aneurysm neck in 1 case(Raymond gradeⅡ).The follow-up time of 8 patients was 3-12 months,including 7 patients with mRS of 0 and 1 patient with mRS of 1.Six patients were followed up by DSA,which showed that 5 patients ac

关 键 词：颅内动脉瘤 血管内操作 大脑前动脉 治疗结果 计算流体动力学 微导管塑形 

分 类 号：R743[医药卫生—神经病学与精神病学]