Leng Xiaochang, Wan Hailin, Li Gaohui, Jiang Yeqing, Huang Lei, Siddiqui Adnan H, Zhang Xiaolong, Xiang Jianping
ArteryFlow Technology Co., Ltd., Hangzhou, China.
School of Civil Engineering and Architecture, Nanchang University, Nanchang, China.
Interv Neuroradiol. 2021 Apr;27(2):181-190. doi: 10.1177/1591019921995334. Epub 2021 Feb 27.
Straightening of parent vessels happens for stent-assisted coiling embolization (SACE) treatment of intracranial aneurysms. This study aims to investigate aneurysmal hemodynamic modifications caused by stent-induced vessel straightening.
Stent and coil deployments of a SACE-treated distal bifurcation aneurysm by finite element method were performed first with the preoperative (not straightened, NS) and postoperative (straightened, S) vessel models respectively. Computational fluid dynamics were then performed for eight models, including (I) NS only model, (II) NS+stent model, (III) NS+coils model, (IV) NS+stent+coils model, (V) S only model, (VI) S+stent model, (VII) S+coils model, and (VIII) S+stent+coils model. Finally, changes in aneurysmal flow velocity, isovelocity surface and wall shear stress (WSS) were analyzed qualitatively and quantitatively.
The flow was less in the S models than that in the corresponding NS models. Coils blocked most of the flow into the aneurysm sac in both NS models and S models and vessel straightening had more profound effect on the high aneurysmal flow volume reduction than coiling, while stenting generated adverse effect on flow reduction. Taking the NS only model as baseline (100%), the sac-averaged velocities of models II to VIII were 112%, 36%, 42%, 45%, 39%, 12%, 13%, and high flow volumes were 119%, 21%, 30%, 10%, 8%, 3%, 3%, while the sac-averaged WSSs were 106%, 37%, 44%, 41%, 35%, 17% and 24%, respectively.
Stent-induced vessel straightening combined coil embolization has the best performance in hemodynamic modifications and may reduce the recurrence rate, whereas stenting may generate adverse effect on hemodynamic alterations.
在颅内动脉瘤的支架辅助弹簧圈栓塞术（SACE）治疗中，母血管会发生伸直。本研究旨在探讨支架诱导的血管伸直所引起的动脉瘤血流动力学改变。
首先分别使用术前（未伸直，NS）和术后（伸直，S）血管模型，通过有限元方法对经SACE治疗的远端分叉动脉瘤进行支架和弹簧圈植入。然后对八个模型进行计算流体动力学分析，包括（I）仅NS模型，（II）NS+支架模型，（III）NS+弹簧圈模型，（IV）NS+支架+弹簧圈模型，（V）仅S模型，（VI）S+支架模型，（VII）S+弹簧圈模型，以及（VIII）S+支架+弹簧圈模型。最后，对动脉瘤内血流速度、等速面和壁面剪切应力（WSS）的变化进行定性和定量分析。
S模型中的血流比相应的NS模型中的血流少。在NS模型和S模型中，弹簧圈均阻断了大部分流入动脉瘤囊的血流，并且血管伸直对高动脉瘤血流量减少的影响比弹簧圈栓塞更为显著，而植入支架对血流量减少产生不利影响。以仅NS模型作为基线（100%），模型II至VIII的瘤囊平均速度分别为112%、36%、42%、45%、39%、12%、13%，高血流量分别为119%、21%、30%、10%、8%、3%、3%，而瘤囊平均WSS分别为106%、37%、44%、41%、35%、17%和24%。
支架诱导的血管伸直联合弹簧圈栓塞在血流动力学改变方面表现最佳，可能会降低复发率，而植入支架可能会对血流动力学改变产生不利影响。
