分支血管直径对颅内动脉瘤置入血流导向装置后血流动力学参数的影响

目的综合考虑血流导向装置(flow diverter,FD)置入对动脉瘤瘤体及分支血管的影响,为临床制定更加合理的FD栓塞颅内动脉瘤手术策略提供参考。方法基于计算流体动力学(computational fluid dynamics,CFD)方法,创新应用多孔介质模型模拟FD栓塞颅内分叉动脉瘤的过程。分析和比较不同分支血管直径条件下FD置入动脉瘤前后瘤体与分支血管血液流场、血流速度、壁面压力、壁面剪切力(wall shear stress,WSS)等血流动力学参数的变化。结果 FD置入改变动脉瘤内的血流动力学特征,血流速度减小,动脉瘤壁尤其是顶部压力减小,瘤颈口WSS增大,但瘤颈远侧端与近侧端WSS的差异减小。且不同分支血管直径对血流动力学特征改变的影响程度不同,直径越大,FD置入后流入分支血管内血流的减少量越大,但瘤体内血液流速与瘤顶压力的减少量越小,同时瘤颈部WSS增加量越小。结论分支血管直径越大,FD对动脉瘤的栓塞治疗效果与对血管粥样硬化的改善作用越差,越易造成分支闭塞或其他缺血性并发症的发生。此类情况下进行FD介入栓塞术尤其需要引起临床医师注意。

Effects from Side Branch Diameter of Intracranial Aneurysm on Hemodynamic Parameters after Flow Diverter Implantation

Objective To comprehensively consider the effect of low diverter (FD) implantation on aneurysmal sac and its branches, so as to provide references for making a more reasonable surgical strategy for intracranial aneurysm embolization in clinical practice. Methods Based on computational fluid dynamics (CFD) method, the FD implantation procedure was simulated by using porous media model innovatively. Changes in hemodynamic parameters of aneurysmal sac and side branch with different diameters before and after FD implantation were compared and analyzed, such as blood flow field, velocity, wall pressure and wall shear stress (WSS). Results FD changed the hemodynamic characteristics of aneurysms. The blood flow velocity decreased significantly. The WSS on aneurysmal neck increased, while the difference of WSS between proximal and distal cervical area reduced conversely. Different side branch diameters of vessels had different effects on hemodynamic characteristic changes. The larger diameter would cause the greater blood flow reduction in side branch after FD implantation, but the decrease in velocity of aneurysmal sac and pressure on aneurysmal roof became smaller simultaneously. Meanwhile, the increase of WSS on aneurysmal neck was inversely proportional to the diameter of side branch. Conclusions The larger branch diameter of vessels would cause the worse effect of FD embolization therapy for intracranial aneurysm, worse atherosclerosis improvements and greater possibilities of branch occlusion or other ischemic complications. Doctors should pay more attention to such cases in FD interventional intravascular embolization in clinic.