Lin Weishen, Ma Xiaokang, Deng Datai, Li Yikai
School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China (mainland).
PERA GLOBAL-Guangzhou Branch, Guangzhou, Guangdong, China (mainland).
Med Sci Monit. 2015 Jun 23;21:1820-6. doi: 10.12659/MSM.892822.
The circle of Willis (CoW) plays an important role in cerebral collateral circulation. The hemodynamics changes in the CoW have usually been associated with the internal carotid artery (ICA) stenosis, but whether rotatory manipulation will affect it remains unknown.
In this study we attempted to analyze the influence of rotatory manipulation on the hemodynamics in the CoW in models with or without ICA stenosis by means of finite element analysis. For this purpose, the CoW was reasonably simplified and a fluid-solid coupling 3D finite element model was created by using MIMICS10.0 and ANSYS14.5. The healthy (without stenosis) and the diseased (ratios of stenosis include 15%, 30%, 45%, 60%, 70%, 80%, and 90%) situations were simulated. A remote displacement of 60° was applied at a distal ICA (the right ICA was chosen here) to imitate the rotatory manipulation. Blood flow was then monitored at the anterior communicating artery (ACoA) and posterior communicating arteries (PCoA).
Before the conduction of rotatory manipulation, blood flow changed significantly only when the stenosis ratio was increased to more than 70%, and the situation did not have significant difference after the application of remote displacement except the model with stenosis ration of 90%.
The result suggests that the rotatory manipulation does not have an obvious influence on the blood flow in the CoW when the stenosis of ICA is less than 90%, and this kind of manipulation is suggested to be a safe technique in most of the clinical applications.
Willis 环（CoW）在脑侧支循环中起重要作用。Willis 环的血流动力学变化通常与颈内动脉（ICA）狭窄有关，但旋转手法是否会影响它仍不清楚。
在本研究中，我们试图通过有限元分析来分析旋转手法对有或无 ICA 狭窄模型中 Willis 环血流动力学的影响。为此，对 Willis 环进行合理简化，并使用 MIMICS10.0 和 ANSYS14.5 创建流固耦合三维有限元模型。模拟了健康（无狭窄）和患病（狭窄比例包括 15%、30%、45%、60%、70%、80%和 90%）情况。在颈内动脉远端（此处选择右侧颈内动脉）施加 60°的远程位移以模拟旋转手法。然后在前交通动脉（ACoA）和后交通动脉（PCoA）监测血流。
在进行旋转手法之前，仅当狭窄比例增加到 70%以上时血流才发生显著变化，并且除狭窄比例为 90%的模型外，施加远程位移后情况没有显著差异。
结果表明，当 ICA 狭窄小于 90%时，旋转手法对 Willis 环血流没有明显影响，并且这种手法在大多数临床应用中被认为是一种安全技术。
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