The Jikei University School of Medicine, Department of Neurosurgery, Tokyo, Japan.
Stroke. 2012 May;43(5):1436-9. doi: 10.1161/STROKEAHA.111.640995. Epub 2012 Feb 23.
We evaluated several hemodynamic parameters for the prediction of rupture in a data set of initially unruptured aneurysms, including aneurysms that ruptured during follow-up observation.
Aneurysm geometry was extracted from CT angiographic images and analyzed using a mathematical formula for fluid flow under pulsatile blood flow conditions. Fifty side-wall internal carotid posterior communicating artery aneurysms and 50 middle cerebral artery bifurcation aneurysms of medium size were investigated for energy loss, pressure loss coefficient, wall shear stress, and oscillatory shear index. During follow-up observation, 6 internal carotid posterior communicating artery and 7 middle cerebral artery aneurysms ruptured (44 and 43 remained unruptured, respectively, with the same location and a similar size as the ruptured cases).
A significant difference in the minimum wall shear stress between aneurysms that ruptured and those that remained unruptured was noted only in internal carotid artery aneurysms (P<0.001). Energy loss showed a higher tendency in ruptured aneurysms but statistically not significant. For pressure loss coefficient, a significant difference was noted in both internal carotid artery (P=0.0046) and middle cerebral artery (P<0.001) aneurysms.
Pressure loss coefficient may be a potential parameter to predict future rupture of unruptured aneurysms.
我们评估了一些血流动力学参数，用于预测初始未破裂动脉瘤的破裂情况，包括在随访观察期间破裂的动脉瘤。
使用脉动血流条件下的流体流动数学公式，从 CT 血管造影图像中提取动脉瘤几何形状，并进行分析。研究了 50 个侧壁颈内动脉后交通动脉瘤和 50 个中型大脑中动脉分叉部动脉瘤的能量损失、压力损失系数、壁切应力和振荡剪切指数。在随访观察期间，6 个颈内动脉后交通动脉瘤和 7 个大脑中动脉动脉瘤破裂（44 个和 43 个仍未破裂，破裂病例的位置和大小相同）。
仅在颈内动脉动脉瘤中观察到破裂和未破裂动脉瘤之间最小壁切应力有显著差异（P<0.001）。能量损失在破裂动脉瘤中表现出更高的趋势，但统计学上无显著性差异。对于压力损失系数，颈内动脉（P=0.0046）和大脑中动脉（P<0.001）动脉瘤均有显著差异。
压力损失系数可能是预测未破裂动脉瘤未来破裂的一个潜在参数。
