串联型颈动脉狭窄的血流动力学模拟分析  

Hemodynamic simulation study of tandem carotid artery stenosis

作　　者：曹俊杰 姚志超 霍桂军 刘占鳌 汤尧[1] 黄剑[1] 周大勇[1] 沈利明[1] CAO Junjie;YAO Zhichao;HUO Guijun;LIU Zhanao;TANG Yao;HUANG Jian;ZHOU Dayong;SHEN Liming(Department of Vascular Surgery,Gusu School of Nanjing Medical University,Suzhou Municipal Hospital,Afiliated Suzhou Hospital of Nanjing Medical University,Suzhou,Jiangsu Province 215000,China)

机构地区：[1]南京医科大学姑苏学院,苏州市立医院,南京医科大学附属苏州医院血管外科,江苏南京215000

出　　处：《介入放射学杂志》2024年第2期150-155,共6页Journal of Interventional Radiology

基　　金：苏州市科教兴卫青年项目(KJXW2020031);南京医科大学姑苏学院科研项目(GSKY20220412、GSKY20210223)。

摘　　要：目的使用计算流体力学(computational fluid dynamic,CFD)对串联型颈动脉狭窄(tandem carotid artery stenosis,TCAS)进行模拟,比较不同手术方式术后的血流动力学改变情况。方法选取1例颈内动脉(internal carotid artery,ICA)和颈总动脉(common carotid artery,CCA)串联型狭窄患者,使用CFD技术对建立的4个颈动脉分叉三维模型(1个真实患者模型,3个假定手术模型)进行血流动力学分析,探索TCAS的发生发展机制并指导选择合适的手术方案。结果在串联型狭窄中,狭窄优先在CCA形成,随后导致ICA狭窄;TCAS较单个颈动脉狭窄的局部血流动力学情况更复杂,风险更高;串联型狭窄中,单个狭窄部位的治疗会影响第二个狭窄部位的血流,并可能导致再狭窄或斑块破裂。结论在规划TCAS手术方案时,对选定TCAS患者进行CFD模拟可帮助临床医生评估术后血流改变情况,指导选择合适的手术方案。Objective By using the computational fluid mechanic(CFD) method the tandem carotid artery stenosis (TCAS) was simulated on the model,and to compare the postoperative hemodynamic changes of different surgical procedures.Methods One patient with tandem stenosis of internal carotid artery (ICA) and common carotid artery(CCA) was selected.CFD technique was used to establish four three-dimensional(3-D) models of the carotid bifurcations,including one model of a real patient and three models of presumptive surgery.The hemodynamic analysis was performed with these models so as to explore the development mechanism of TCAS and to discuss the selection of suitable surgical plan.Results In tandem stenosis,the stenosis was preferentially formed in CCA and subsequently led to ICA stenosis.The local hemodynamic situation in TCAS was more complex and more risky than in single carotid artery stenosis.In tandem stenosis,the treatment of one stenosis site would affect the blood flow at the next stenosis site and cause restenosis or plaque rupture.Conclusion In treating patients with TCAS,CFD simulation examination should be performed when the surgical plan is formulated,which can help clinicians to predict the postoperative changes in blood flow and to choose the appropriate surgical plan.(J Intervent Radiol,2024,32:150-155)

关 键 词：颈动脉狭窄 串联病变 血流动力学 计算流体力学 

分 类 号：R743.3[医药卫生—神经病学与精神病学]