针对两个患者特异性分叉动脉瘤的虚拟血流导向支架置入术
Virtual Flow-T Stenting for Two Patient-Specific Bifurcation Aneurysms.
作者信息
Lyu Mengzhe, Ventikos Yiannis, Peach Thomas W, Makalanda Levansri, Bhogal Pervinder
机构信息
Department of Mechanical Engineering, University College London (UCL), London, United Kingdom.
School of Life Science, Beijing Institute of Technology, Beijing, China.
出版信息
Front Neurol. 2021 Nov 3;12:726980. doi: 10.3389/fneur.2021.726980. eCollection 2021.
The effective treatment of wide necked cerebral aneurysms located at vessel bifurcations (WNBAs) remains a significant challenge. Such aneurysm geometries have typically been approached with Y or T stenting configurations of stents and/or flow diverters, often with the addition of endovascular coils. In this study, two WNBAs were virtually treated by a novel T-stenting technique (Flow-T) with a number of braided stents and flow-diverter devices. Multiple possible device deployment configurations with varying device compression levels were tested, using fast-deployment algorithms, before a steady state computational hemodynamic simulation was conducted to examine the efficacy and performance of each scenario. The virtual fast deployment algorithm based on a linear and torsional spring analogy is used to accurately deploy nine stents in two WNBAs geometries. The devices expand from the distal to proximal side of the devices with respect to aneurysm sac. In the WNBAs modelled, all configurations of Flow-T device placement were shown to reduce factors linked with increased aneurysm rupture risk including aneurysm inflow jets and high aneurysm velocity, along with areas of flow impingement and elevated wall shear stress (WSS). The relative position of the flow-diverting device in the secondary daughter vessel in the Flow-T approach was found to have a negligible effect on overall effectiveness of the procedure in the two geometries considered. The level of interventionalist-applied compression in the braised stent that forms the other arm of the Flow-T approach was shown to impact the aneurysm inflow reduction and aneurysm flow pattern more substantially. In the Flow-T approach the relative position of the secondary daughter vessel flow-diverter device (the SVB) was found to have a negligible effect on inflow reduction, aneurysm flow pattern, or WSS distribution in both aneurysm geometries. This suggests that the device placement in this vessel may be of secondary importance. By contrast, substantially more variation in inflow reduction and aneurysm flow pattern was seen due to variations in braided stent (LVIS EVO or Baby Leo) compression at the aneurysm neck. As such we conclude that the success of a Flow-T procedure is primarily dictated by the level of compression that the interventionalist applies to the braided stent. Similar computationally predicted outcomes for both aneurysm geometries studied suggest that adjunct coiling approach taken in the clinical intervention of the second geometry may have been unnecessary for successful aneurysm isolation. Finally, the computational modelling framework proposed offers an effective planning platform for complex endovascular techniques, such as Flow-T, where the scope of device choice and combination is large and selecting the best strategy and device combination from several candidates is vital.
有效治疗位于血管分叉处的宽颈脑动脉瘤(WNBAs)仍然是一项重大挑战。对于这种动脉瘤的几何形态,通常采用Y形或T形支架配置的支架和/或血流导向装置进行处理,通常还会添加血管内线圈。在本研究中,使用多个编织支架和血流导向装置,通过一种新型T形支架技术(Flow-T)对两个WNBAs进行了虚拟治疗。在进行稳态计算血流动力学模拟以检查每种方案的疗效和性能之前,使用快速部署算法测试了具有不同装置压缩水平的多种可能的装置部署配置。基于线性和扭转弹簧类比的虚拟快速部署算法用于在两个WNBAs几何形态中准确部署九个支架。装置相对于动脉瘤囊从远端向近端扩张。在所建模的WNBAs中,Flow-T装置放置的所有配置均显示可降低与动脉瘤破裂风险增加相关的因素,包括动脉瘤流入射流和高动脉瘤流速,以及血流冲击区域和升高的壁面剪应力(WSS)。发现在Flow-T方法中,血流导向装置在二级分支血管中的相对位置对所考虑的两种几何形态中该手术的总体有效性影响可忽略不计。构成Flow-T方法另一臂的编织支架中,介入医生施加的压缩水平对动脉瘤流入减少和动脉瘤血流模式的影响更为显著。在Flow-T方法中,发现在两种动脉瘤几何形态中,二级分支血管血流导向装置(SVB)的相对位置对流入减少、动脉瘤血流模式或WSS分布的影响可忽略不计。这表明该装置在该血管中的放置可能是次要的。相比之下,由于动脉瘤颈部编织支架(LVIS EVO或Baby Leo)压缩的变化,在流入减少和动脉瘤血流模式方面观察到的变化要大得多。因此,我们得出结论,Flow-T手术的成功主要取决于介入医生对编织支架施加的压缩水平。对所研究的两种动脉瘤几何形态进行的类似计算预测结果表明,在第二种几何形态的临床干预中采用的辅助线圈置入方法对于成功隔离动脉瘤可能是不必要的。最后,所提出的计算建模框架为复杂的血管内技术(如Flow-T)提供了一个有效的规划平台,在这种技术中,装置选择和组合的范围很大,从多个候选方案中选择最佳策略和装置组合至关重要。
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