颅内颈动脉狭窄翼点支架置入后新发动脉瘤形成：计算血流动力学分析。
De Novo Aneurysm Formation After Wingspan Stenting of Intracranial Carotid Stenosis: Computational Hemodynamic Analysis.
机构信息
Department of Interventional Neuroradiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of Interventional Neuroradiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
出版信息
World Neurosurg. 2019 Jun;126:212-215. doi: 10.1016/j.wneu.2019.03.035. Epub 2019 Mar 13.
BACKGROUND
The pathophysiology of de novo aneurysm after stenting is poorly understood. Hemodynamic effects may play an important role. We report and discuss the hemodynamic analysis of de novo aneurysm after intracranial stenting.
CASE DESCRIPTION
A 51-year-old female underwent angioplasty and coiling for stenosis associated with an aneurysm of the left intracranial carotid artery. Six years later, the follow-up digital subtraction angiography demonstrated a de novo aneurysm at the proximal tine of the Wingspan stent. Computational fluid dynamics simulations showed that stenting for intracranial stenosis resulted in higher oscillatory shear index and lower time-averaged wall shear stress in the neck region of de novo aneurysm.
CONCLUSIONS
The hemodynamic change after stenting may lead to formation of a de novo aneurysm. After an initial injury that might result from the tine on the endothelial cells, stenting could produce high oscillatory shear index and low time-averaged wall shear stress near the tine, thus potentially inducing de novo aneurysm formation.
背景
支架置入后新发动脉瘤的病理生理学机制尚不清楚，血流动力学因素可能发挥重要作用。我们报告并讨论了颅内支架置入后新发动脉瘤的血流动力学分析。
病例描述
一名 51 岁女性因左侧颈内动脉狭窄伴发动脉瘤行血管成形术和线圈栓塞治疗。6 年后，随访数字减影血管造影显示 Wingspan 支架近端出现新发动脉瘤。计算流体动力学模拟显示，颅内狭窄支架置入后，新发动脉瘤颈部的脉动剪切指数升高，壁面切应力的时间平均值降低。
结论
支架置入后的血流动力学变化可能导致新发动脉瘤的形成。在初始损伤之后，支架置入可能会在支架的边缘附近产生高脉动剪切指数和低壁面切应力的时间平均值，从而潜在地诱导新发动脉瘤的形成。
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