Lipp Sarah N, Niedert Elizabeth E, Cebull Hannah L, Diorio Tyler C, Ma Jessica L, Rothenberger Sean M, Stevens Boster Kimberly A, Goergen Craig J
Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States.
School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States.
Front Physiol. 2020 May 12;11:454. doi: 10.3389/fphys.2020.00454. eCollection 2020.
Arterial aneurysms are pathological dilations of blood vessels, which can be of clinical concern due to thrombosis, dissection, or rupture. Aneurysms can form throughout the arterial system, including intracranial, thoracic, abdominal, visceral, peripheral, or coronary arteries. Currently, aneurysm diameter and expansion rates are the most commonly used metrics to assess rupture risk. Surgical or endovascular interventions are clinical treatment options, but are invasive and associated with risk for the patient. For aneurysms in locations where thrombosis is the primary concern, diameter is also used to determine the level of therapeutic anticoagulation, a treatment that increases the possibility of internal bleeding. Since simple diameter is often insufficient to reliably determine rupture and thrombosis risk, computational hemodynamic simulations are being developed to help assess when an intervention is warranted. Created from subject-specific data, computational models have the potential to be used to predict growth, dissection, rupture, and thrombus-formation risk based on hemodynamic parameters, including wall shear stress, oscillatory shear index, residence time, and anomalous blood flow patterns. Generally, endothelial damage and flow stagnation within aneurysms can lead to coagulation, inflammation, and the release of proteases, which alter extracellular matrix composition, increasing risk of rupture. In this review, we highlight recent work that investigates aneurysm geometry, model parameter assumptions, and other specific considerations that influence computational aneurysm simulations. By highlighting modeling validation and verification approaches, we hope to inspire future computational efforts aimed at improving our understanding of aneurysm pathology and treatment risk stratification.
动脉瘤是血管的病理性扩张,由于血栓形成、夹层分离或破裂,可能引发临床关注。动脉瘤可在整个动脉系统中形成,包括颅内、胸、腹、内脏、外周或冠状动脉。目前,动脉瘤直径和扩张率是评估破裂风险最常用的指标。外科手术或血管内介入是临床治疗选择,但具有侵入性且对患者有风险。对于以血栓形成为主要关注点的部位的动脉瘤,直径也用于确定治疗性抗凝的水平,而这种治疗会增加内出血的可能性。由于单纯的直径往往不足以可靠地确定破裂和血栓形成风险,因此正在开发计算流体动力学模拟,以帮助评估何时需要进行干预。基于特定个体数据创建的计算模型有潜力用于根据包括壁面剪应力、振荡剪应力指数、停留时间和异常血流模式在内的流体动力学参数来预测生长、夹层分离、破裂和血栓形成风险。一般来说,动脉瘤内的内皮损伤和血流停滞可导致凝血、炎症以及蛋白酶的释放,这些会改变细胞外基质组成,增加破裂风险。在本综述中,我们重点介绍了最近的研究工作,这些工作探讨了动脉瘤几何形状、模型参数假设以及影响动脉瘤计算模拟的其他具体因素。通过强调建模验证和验证方法,我们希望激发未来的计算研究工作,以增进我们对动脉瘤病理学和治疗风险分层的理解。