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影响的数值仿真
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1.上海理工大学上海介入医疗器械工程技术研究中心;2.上海微创医疗器械集团有限公司

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上海工程技术研究中心资助项目(18DZ2250900)


Hemodynamic Changes on Intracranial Aneurysm after Flow Diverter Implantation Influenced by Side Branch Diameter Using Numerical Simulation
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1.University of Shanghai for Science and Technology(Shanghai Engineering Research Center of Interventional Medical Devices);2.Shanghai MicroPort Medical Group Co,Ltd

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    摘要:

    目的 综合考虑血流导向装置(Flow Diverter, FD)的置入对动脉瘤瘤体及分支血管的影响,有利于在临床上制定更加合理的FD栓塞颅内动脉瘤手术策略。方法 本文基于计算流体力学(Computational Fluid Dynamics, CFD)技术,创新应用多孔介质模型模拟了FD栓塞颅内分叉动脉瘤的过程。结果 FD的置入改变了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;瘤颈口壁面切应力(Wall Shear Stress, WSS)增大,但瘤颈远侧端与近侧端差异减小。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的增加量越小。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,且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介入栓塞术时尤其需要引起临床医师们的注意。

    Abstract:

    Objective A comprehensive consideration of therapeutic effect on tumors and its branches with Flow Diverter(FD) implantation is conducive to make a more reasonable surgical strategy for intracranial aneurysm embolization in clinical practice. Methods Based on computational fluid dynamics(CFD) technique, our paper simulated FD implantation procedure using porous media model innovatively. Results FD changed the hemodynamic characteristics of aneurysms. Specifically, when FD was implanted, the blood velocity decreased, the wall pressure on tumor roof also decreased significantly, while the wall shear stress(WSS) on aneurysmal neck increased, inversely, the difference between proximal and distal cervical area reduced. What is more, different side branch vessels have different effects on hemodynamic characteristic changes. When branching diameters were larger, the blood flow reduction in themselves after FD implantation was greater, but the velocity in tumor and the pressure on aneurysmal roof were smaller simultaneously. Meanwhile, the increment of WSS on aneurysmal neck was inversely proportional to the side branch diameter. Conclusion Under the circumstance of thicker side vessels, FD interventional treatment should be paid more attention by clinicians, on account of worse embolization、worse atherosclerosis improvements and more possibilities of branch occlusion or other ischemic complications.

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  • 收稿日期:2019-04-20
  • 最后修改日期:2019-08-05
  • 录用日期:2019-08-05
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