Liu Jian, Jing Linkai, Wang Chao, Zhang Ying, Yang Xinjian
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
World Neurosurg. 2016 May;89:726.e5-726.e10. doi: 10.1016/j.wneu.2016.01.002. Epub 2016 Jan 9.
Delayed rupture of a previously coiled unruptured aneurysm is extremely rare, and no hemodynamic analysis of such aneurysms has been reported during the postprocedural course.
We present a case of an initially successfully embolized, unruptured anterior communicating artery aneurysm that subsequently underwent recanalization, regrowth, and delayed rupture 35 months after embolization. We used computational fluid dynamics to determine the hemodynamics at different stages during longitudinal follow-up and to evaluate wall shear stress (WSS) and flow velocity at peak systole. We found that high-flow impingement was associated with recanalization, that regrowth as bleb formation was induced by high WSS and flow velocity, and that low WSS was a risk factor for aneurysm rupture.
Heterogeneous hemodynamic characteristics were involved in the outcomes of intracranial aneurysm after endovascular treatment. High-flow impingement and WSS were associated with recanalization and regrowth, whereas low WSS was associated with aneurysm rupture.
先前已栓塞的未破裂动脉瘤延迟破裂极为罕见，且在术后过程中尚未见对此类动脉瘤进行血流动力学分析的报道。
我们报告一例最初成功栓塞的未破裂前交通动脉瘤病例，该动脉瘤在栓塞后35个月出现再通、瘤体再生长及延迟破裂。我们采用计算流体动力学方法来确定纵向随访不同阶段的血流动力学情况，并评估收缩期末的壁面切应力（WSS）和流速。我们发现高血流冲击与再通相关，高WSS和流速诱导瘤体以小泡形成的方式再生长，而低WSS是动脉瘤破裂的一个危险因素。
血管内治疗后颅内动脉瘤的转归涉及异质性血流动力学特征。高血流冲击和WSS与再通及再生长相关，而低WSS与动脉瘤破裂相关。
