Alkhalili Kenan, Hannallah Jack, Cobb Mary, Chalouhi Nohra, Philips Jessica L, Echeverria Angela B, Jabbour Pascal, Babiker M Haithem, Frakes David H, Gonzalez L Fernando
Department of Surgery, University of Arizona, Tucson, Arizona, USA.
Division of Neurosurgery, Duke University, Durham, NC, USA.
Asian J Neurosurg. 2018 Apr-Jun;13(2):201-211. doi: 10.4103/1793-5482.175639.
The etiology of up to 95% of cerebral aneurysms may be accounted for by hemodynamically-induced factors that create vascular injury. The purpose of this review is to describe key physical properties that stents have and how they affect cerebral aneurysms. We performed a two-step screening process. First, a structured search was performed using the PubMed database. The following search terms and keywords were used: "Hemodynamics," "wall shear stress (WSS)," "velocity," "viscosity," "cerebral aneurysm," "intracranial aneurysm," "stent," "flow diverter," "stent porosity," "stent geometry," "stent configuration," and "stent design." Reports were considered if they included original data, discussed hemodynamic changes after stent-based treatment of cerebral aneurysms, examined the hemodynamic effects of stent deployment, and/or described the geometric characteristics of both stents and the aneurysms they were used to treat. The search strategy yielded a total of 122 articles, 61 were excluded after screening the titles and abstracts. Additional articles were then identified by cross-checking reference lists. The final collection of 97 articles demonstrates that the geometric characteristics and configurations of deployed stents influenced hemodynamic parameters such as aneurysmal WSS, inflow, and pressure. The geometric characteristics of the aneurysm and its position also had significant influences on intra-aneurysmal hemodynamics after treatment. In conclusion, changes in specific aneurysmal hemodynamic parameters that result from stenting relate to a number of factors including the geometric properties and configurations of deployed stents, the geometric properties of the aneurysm, and the pretreatment hemodynamics.
高达95%的脑动脉瘤病因可能是由造成血管损伤的血流动力学诱导因素引起的。本综述的目的是描述支架所具有的关键物理特性以及它们如何影响脑动脉瘤。我们进行了两步筛选过程。首先，使用PubMed数据库进行结构化搜索。使用了以下搜索词和关键词：“血流动力学”、“壁面剪应力（WSS）”、“速度”、“粘度”、“脑动脉瘤”、“颅内动脉瘤”、“支架”、“血流导向装置”、“支架孔隙率”、“支架几何形状”、“支架构型”和“支架设计”。如果报告包含原始数据、讨论了基于支架治疗脑动脉瘤后的血流动力学变化、研究了支架置入后的血流动力学影响和/或描述了支架及其所治疗动脉瘤的几何特征，则予以考虑。搜索策略共产生122篇文章，在筛选标题和摘要后排除了61篇。然后通过交叉核对参考文献列表确定了其他文章。最终收集的97篇文章表明，置入支架的几何特征和构型影响血流动力学参数，如动脉瘤壁面剪应力、流入和压力。动脉瘤的几何特征及其位置对治疗后动脉瘤内的血流动力学也有显著影响。总之，支架置入导致的特定动脉瘤血流动力学参数变化与许多因素有关，包括置入支架的几何特性和构型、动脉瘤的几何特性以及治疗前的血流动力学。
