血管内治疗颅内动脉瘤后复发的血流动力学数值模拟研究

摘要

Objective To investigate the role of hemodynamics in the recurrent intracranial aneu-rysms after endovascular treatment. Methods Ten patients with recurrent intracranial aneurysm and 10 with non-recurrent aneurysm were selected in the Department of Neurosurgery, Changhai Hospital, the Second Military Medical University from 2006 to October 2009 by matching the conditions of site, size and shape of the aneurysms. A numerical simulation method was used to analyze the aneurysm necks in both groups including the hemodynamic characteristics of wall shear stress, pressure and blood flow velocity. Results The median ( range ) of the wall shear stress at the proximal, central and distal parts of aneurysm neck in the recurrent aneurysm group was 3. 19 ( 0. 92 - 22. 73 ), 3. 19 ( 1. 04 - 23. 01 ) and 5. 03 ( 1. 88 -23. 06 ) Pa, respectively. The wall shear stress at the distal parts of aneurysm neck was significantly higher than that at the central and proximal parts. There were significant differences among the 3 portions ( P = 0. 002 ). The wall shear stress of the 3 corresponding portions in the non-recurrent aneurysm group was 5. 61 ( 0.96 -9. 59 ), 5. 55 ( 4. 56 - 7. 88 ) and 5. 88 ( 4. 06 - 10. 75 ), respectively. There were no significant differences. There were no significant differences in the blood flow velocity and pressure of the proximal, central and distal of portions aneurysm neck between the recurrent aneurysm group and the non-recurrent aneurysm group. Conclusion The local high wall shear stress was associated with the aneurysmal recurrence after endovascular treatment of aneurysms.%目的 探讨血流动力学在颅内动脉瘤血管内治疗后复发中的作用.方法 2006年6月-2009年10月第二军医大学长海医院神经外科,通过匹配动脉瘤部位、大小和形态等条件,选择复发与未复发动脉瘤患者各10例,采用数值模拟的计算方法,分析两组动脉瘤瘤颈不同部位,包括壁面切应力、压力和血流速度在内的血流动力学特征.结果 动脉瘤复发组的瘤颈近侧、中心及远侧3个部位的壁面切应力的中位数(范围)分别为3.19(0.92~22.73)、3.19(1.04~23.01)和5.03(1.88~23.06)Pa,在瘤颈远侧端的壁面切应力明显高于瘤颈中心部位和瘤颈近端,差异有统计学意义,P=0.002;未复发组相应的三个部位的切应力分别为5.61(0.96~9.59)、5.55(4.56~7.88)、5.88(4.06~10.75),差异无统计学意义.复发组及未复发组的瘤颈近侧、中心及远侧的血流速度及压力比较差异均无统计学意义.结论 血管内治疗颅内动脉瘤后,局部高壁面切应力与动脉瘤复发有关.