Mut Fernando, Raschi Marcelo, Scrivano Esteban, Bleise Carlos, Chudyk Jorge, Ceratto Rosana, Lylyk Pedro, Cebral Juan R
Center for Computational Fluid Dynamics, George Mason University, Fairfax, Virginia, USA Instituto de Ciências Matemáticas e de Computação, Universidade de São Paulo, São Carlos, Brazil.
Center for Computational Fluid Dynamics, George Mason University, Fairfax, Virginia, USA.
J Neurointerv Surg. 2015 Apr;7(4):286-90. doi: 10.1136/neurintsurg-2013-011080. Epub 2014 Apr 2.
Evaluation of flow diversion treatment of intracranial aneurysms is difficult owing to lack of knowledge of the target hemodynamic environment.
To identify hemodynamic conditions created after flow diversion that induce fast aneurysm occlusion.
Two groups of aneurysms treated with flow diverters alone were selected: (a) aneurysms completely occluded at 3 months (fast occlusion), and (b) aneurysms patent or incompletely occluded at 6 months (slow occlusion). A total of 23 aneurysms were included in the study. Patient-specific computational fluid dynamics models were constructed and used to characterize the hemodynamic environment immediately before and after treatment. Average post-treatment hemodynamic conditions between the fast and slow occlusion groups were statistically compared.
Aneurysms in the fast occlusion group had significantly lower post-treatment mean velocity (fast=1.13 cm/s, slow=3.11 cm/s, p=0.02), inflow rate (fast=0.47 mL/s, slow=1.89 mL/s, p=0.004) and shear rate (fast=20.52 1/s, slow=32.37 1/s, p=0.02) than aneurysms in the slow occlusion group. Receiver operating characteristics analysis showed that mean post-treatment velocity, inflow rate, and shear rate below a certain threshold could discriminate between aneurysms of the fast and slow occlusion groups with good accuracy (84%, 77%, and 76%, respectively).
The occlusion time of cerebral aneurysms treated with flow diverters can be predicted by the hemodynamic conditions created immediately after device implantation. Specifically, low post-implantation flow velocity, inflow rate, and shear rate are associated with fast occlusion times.
由于对目标血流动力学环境缺乏了解，颅内动脉瘤血流导向治疗的评估较为困难。
确定血流导向治疗后导致动脉瘤快速闭塞的血流动力学条件。
选择两组仅接受血流导向装置治疗的动脉瘤：（a）3个月时完全闭塞的动脉瘤（快速闭塞），以及（b）6个月时仍通畅或不完全闭塞的动脉瘤（缓慢闭塞）。本研究共纳入23个动脉瘤。构建了患者特异性计算流体动力学模型，并用于表征治疗前后的血流动力学环境。对快速闭塞组和缓慢闭塞组治疗后的平均血流动力学条件进行统计学比较。
快速闭塞组的动脉瘤治疗后的平均速度（快速闭塞组=1.13 cm/s，缓慢闭塞组=3.11 cm/s，p=0.02）、流入率（快速闭塞组=0.47 mL/s，缓慢闭塞组=1.89 mL/s，p=0.004）和剪切率（快速闭塞组=20.52 1/s，缓慢闭塞组=32.37 1/s，p=0.02）均显著低于缓慢闭塞组的动脉瘤。受试者工作特征分析表明，治疗后的平均速度、流入率和剪切率低于某一阈值时，能够较好地区分快速闭塞组和缓慢闭塞组的动脉瘤（准确率分别为84%、77%和76%）。
血流导向装置治疗的脑动脉瘤闭塞时间可通过装置植入后即刻产生的血流动力学条件进行预测。具体而言，植入后低血流速度、流入率和剪切率与快速闭塞时间相关。
