Tateshima Satoshi, Tanishita Kazuo, Omura Hiroyoshi, Sayre James, Villablanca J Pablo, Martin Neil, Vinuela Fernando
Division of Interventional Neuroradiology, University of California, Los Angeles, Medical Center, CA 90095-1721, USA.
Surg Neurol. 2008 Nov;70(5):454-62; discussion 462. doi: 10.1016/j.surneu.2008.03.035. Epub 2008 Jun 2.
The remodeling of arterial extra-cellular matrix induced by hemodynamic stimuli is involved in the process of atherosclerosis in the carotid and cerebral arteries. Scarce information is available on the relationship between atherosclerotic changes in brain aneurysms itself and its intra-aneurysmal hemodynamics.
Surgical exploration of a large MCA aneurysm depicted extensive atherosclerotic changes in the aneurysm wall. Computational tomographic angiography of this aneurysm was used to create an in vitro aneurysm model. This model was used to perform intra-aneurysmal flow measurement using particle imaging velocimetry and LDV. Intra-aneurysmal hemodynamic pattern with wall shear stress distribution was compared between areas with and without atherosclerotic changes.
No high oscillation of wall shear stress was observed on the atherosclerotic plaque area. However, the magnitude of wall shear stress tended to be higher in the area without atherosclerotic changes than the area with those changes (P < .001). There was no atherosclerotic change at the aneurysm inflow zone, where relatively fast flow velocity and higher magnitude of wall shear stress was noted.
This single case of atherosclerosis in an aneurysm shows some similarity in hemodynamic values observed in cases of carotid atherosclerotic plaques.
血流动力学刺激诱导的动脉细胞外基质重塑参与颈动脉和脑动脉的动脉粥样硬化过程。关于脑动脉瘤本身的动脉粥样硬化变化与其瘤内血流动力学之间的关系，现有信息较少。
对一例大型大脑中动脉瘤进行手术探查，发现瘤壁存在广泛的动脉粥样硬化改变。利用该动脉瘤的计算机断层血管造影创建体外动脉瘤模型。使用粒子图像测速技术和激光多普勒测速仪对该模型进行瘤内血流测量。比较有和没有动脉粥样硬化改变区域的瘤内血流动力学模式及壁面剪应力分布。
在动脉粥样硬化斑块区域未观察到壁面剪应力的高振荡。然而，没有动脉粥样硬化改变区域的壁面剪应力大小往往高于有改变的区域（P <.001）。在动脉瘤流入区未发现动脉粥样硬化改变，该区域流速相对较快且壁面剪应力大小较高。
该例动脉瘤合并动脉粥样硬化的情况在观察到的血流动力学值方面与颈动脉粥样硬化斑块病例有一些相似之处。
