摘要
目的探讨大脑前动脉(ACA)分叉形态学与前交通动脉瘤朝向的关系,分析血管内支架改变外侧角角度在临床防治动脉瘤中的作用。方法对 698 例患者作 DSA 造影,其中 171 例前交通动脉瘤患者和 527 例无瘤患者。测量 ACA 分叉角度、动脉瘤朝向,通过动脉分叉顶端纵线和横线采线方法定量分析血流动力学应力(动态压力、总压力、剪切力、涡流强度和应变率)。结果前交通动脉瘤多偏向小角度外侧角(P<0.001)。计算流体力学(CFD)分析 40 例 ACA 分叉顶端结果显示,与 ACA-A1 段形成小角度的分支血管管壁 Peak 位点血流动力学应力显著大于对侧分支血管(P<0.001)。结论与主干血管形成小外侧角的分支血管管壁异常增大的血流动力学应力,可能促进动脉瘤形成。临床上采用弹簧圈结合支架治疗动脉瘤时选择将一字形支架植于小外侧角处,利用支架自身弹性回复扩大外侧角,可能是防治动脉瘤的有效方法。
Objective To investigate the relationship between the morphology of anterior cerebral artery (ACA) bifurcation and the orientation of anterior communicating artery aneurysm, and to analyzed the role of intravascular stenting in preventing and treating aneurysm by changing the lateral angle. Methods The digital subtraction angiography (DSA) was performed in 698 patients. DSA showed that 171 patients had anterior communicating artery aneurysms and 527 patients had no aneurysms. The bifurcation angle of ACA and the orientation of the aneurysm were measured. Quantitative analysis of hemodynamic stresses, including dynamic pressure, total pressure, shear force, vorticity and strain rate, were conducted by drawing longitudinal and transverse lines at the top of the artery bifurcation. Results Most anterior communicating artery aneurysms were associated with a smaller lateral angle (P<0.001). Computational fluid dynamics (CFD) analysis of ACA bifurcation top in 40 patients revealed that the hemodynamic stresses at peak site of the branching vascular wall that participated in forming a small angle with ACA - A1 segment was remarkably larger than that of the contralateral branching vascular wall (P <0.001). Conclusion The abnormally increased hemodynamic stresses on the vascular wall of the branching vessel that forms a small lateral angle with the parent vessel may promote the formation of aneurysm. Clinically, the implantation of straight line - shaped stent at the site of smaller lateral angle so as to expand the lateral angle with the elastic recovery of the stent may be an effective method to prevent and treat aneurysms.
作者
张学敬
郝伟丽
杨松涛
吴颂时
高不郎
ZHANG Xuejing;HAO Weili;YANG Songtao;WU Songshi;GAO Bulang(Scientific Research Center of Shijiazhuang Municipal First Hospital, Shijiazhuang, Hebei Province 050011, China)
出处
《介入放射学杂志》
CSCD
北大核心
2019年第7期625-629,共5页
Journal of Interventional Radiology
