Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich, Switzerland.
Am J Physiol Heart Circ Physiol. 2011 Apr;300(4):H1451-8. doi: 10.1152/ajpheart.00871.2010. Epub 2011 Feb 4.
Spontaneous internal carotid artery (ICA) dissection (sICAD) results from an intimal tear located around the distal carotid sinus. The mechanisms causing the tear are unknown. This case-control study tested the hypotheses that head movements increase the wall stress in the cervical ICA and that the stress increase is greater in patients with sICAD than in controls. Five patients with unilateral, recanalized, left sICAD and five matched controls were investigated before and after maximal head rotation to the left and neck hyperextension after 45° head rotation to the left. The anatomy of the extracranial carotid arteries was assessed by magnetic resonance imaging and used to create finite element models of the right ICA. Wall stress increased after head movements. Increases above the 80th and 90th percentile were located at the intimal side of the artery wall from 7.4 mm below to 10 mm above the cranial edge of the carotid sinus, i.e., at the same location as histologically confirmed tears in patients with sICAD. Wall stress increase did not differ between patients and controls. The present findings suggest that wall stress increases at the intimal side of the artery wall surrounding the distal edge of the carotid bulb after head movements may be important for the development of carotid dissection. The lack of wall stress difference between the two groups indicates that the carotid arteries of patients with carotid dissection have either distinct functional or anatomical properties or endured unusually heavy wall stresses to initiate dissection.
自发性颈内动脉夹层（sICAD）是由于颈动脉窦远端的内膜撕裂引起的。导致撕裂的机制尚不清楚。本病例对照研究检验了以下假设：头部运动增加颈内动脉（ICA）的壁应力，并且 sICAD 患者的应力增加大于对照组。研究了 5 名单侧、再通的左侧 sICAD 患者和 5 名匹配的对照组患者，在最大程度地向左侧旋转头部以及在向左侧旋转 45°后过度伸展颈部之前和之后，对他们的左侧进行了检查。通过磁共振成像评估颅外颈动脉的解剖结构，并用于创建右侧 ICA 的有限元模型。头部运动后壁应力增加。增加量位于高于 80%和 90%的位置，位于颈动脉窦颅缘下 7.4 毫米至 10 毫米的动脉壁内膜侧，即与 sICAD 患者组织学确认的撕裂位置相同。患者和对照组之间的壁应力增加没有差异。目前的研究结果表明，头部运动后，颈动脉窦远端的动脉壁内膜侧的壁应力增加可能对颈动脉夹层的发展很重要。两组之间没有壁应力差异表明，颈动脉夹层患者的颈动脉具有明显的功能或解剖特性，或者承受了异常大的壁应力以引发夹层。
