Zhang Xue-Jing, Li Cong-Hui, Hao Wei-Li, Zhang Dong-Hai, Ren Chun-Feng, Gao Bu-Lang
Department of Neurosurgery, The First Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, China; Department of Medical Research, Shijiazhuang First Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, China.
Department of Neurosurgery, The First Hospital, Hebei Medical University, Shijiazhuang, Hebei Province, China.
World Neurosurg. 2018 Dec;120:e783-e791. doi: 10.1016/j.wneu.2018.08.167. Epub 2018 Aug 31.
To investigate the relationship of anterior cerebral artery (ACA) bifurcation angles with hemodynamic stresses for aneurysm initiation.
Forty patients with or without anterior communicating artery aneurysms were enrolled, and 3 patients with ACA bifurcation angles of 169.0°, 136.9°, and 73.2°, respectively, were entered into computational fluid dynamics analysis for hemodynamic stresses.
Larger bifurcation angles had a larger direct flow impinging zone and larger peak pressure area. In the direct flow impinging center, the total pressure was the highest, whereas the other stresses were the lowest. As blood flowed distally, the total pressure decreased rapidly, whereas all other parameters increased quickly to their peaks. The hemodynamic peak distance was decreased as the bifurcation angle became narrower. The total pressure summit and the peak hemodynamic stresses all decreased with the decrease of bifurcation angles. The distance between the hemodynamic peaks was the smallest at 73.2° compared with larger angles. A significant (P < 0.01) positive linear correlation existed in the ACA bifurcation angle with the distance between hemodynamic stress peaks or in the ACA branch diameter with the distance from the direct impinging center to the ipsilateral hemodynamic stress peak. The hemodynamic stresses on the aneurysm dome were significantly (P < 0.001) smaller than at the aneurysm initiation site.
Larger bifurcation angles may lead to abnormally enhanced hemodynamic stresses, enlarged zones of direct flow impingement, and increased distance between hemodynamic stress peaks to damage the vascular wall for aneurysm initiation on the bifurcation apex wall.
研究大脑前动脉（ACA）分叉角度与动脉瘤起始处血流动力学应力之间的关系。
纳入40例有或无前交通动脉瘤的患者，选取3例ACA分叉角度分别为169.0°、136.9°和73.2°的患者进行血流动力学应力的计算流体动力学分析。
较大的分叉角度具有更大的直流冲击区和更大的峰值压力区域。在直流冲击中心，总压力最高，而其他应力最低。随着血液向远端流动，总压力迅速下降，而所有其他参数迅速上升至峰值。随着分叉角度变窄，血流动力学峰值距离减小。随着分叉角度减小，总压力峰值和血流动力学应力峰值均降低。与较大角度相比，在73.2°时血流动力学峰值之间的距离最小。ACA分叉角度与血流动力学应力峰值之间的距离存在显著（P < 0.01）正线性相关，或者ACA分支直径与从直接冲击中心到同侧血流动力学应力峰值的距离存在显著正线性相关。动脉瘤瘤顶处的血流动力学应力显著（P < 0.001）小于动脉瘤起始部位。
较大的分叉角度可能导致血流动力学应力异常增强、直流冲击区域扩大以及血流动力学应力峰值之间的距离增加，从而损伤分叉顶端壁上的血管壁，引发动脉瘤。
