Ren Shuqi, Liu Qijia, Chen Zengsheng, Deng Xiaoyan, Sun Anqiang, Luan Jingyuan
Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.
Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China.
Front Cardiovasc Med. 2022 Oct 20;9:993037. doi: 10.3389/fcvm.2022.993037. eCollection 2022.
A carotid web is a thin, shelf-like luminal protrusion in the internal carotid artery that might cause carotid stenosis and stroke by inducing disturbed flow patterns, thrombosis, and abnormal biomechanical stimulus to the endothelial cells. This study simulated and evaluated how the two main treatments (endarterectomy and stenting) influence hemodynamic environments in the carotid artery and distal carotid siphon arteries, aiming to provide more references for the selection of clinical treatment.
The carotid web, endarterectomy, and stenting models were reconstructed based on CT images. The blood flow simulations were conducted, and critical parameters related to thrombosis formation and artery remodeling, including swirling strength, wall shear stress (WSS), vortex Q-criterion, and oscillating shear index (OSI), were analyzed.
In the model of the carotid web, obvious recirculation formed distal to the web, accompanied by lower velocity, lower WSS, higher relative resident time (RRT), and higher Q value. While in both two treatment models, the velocity increased and the Q value and RRT decreased at the carotid bifurcation. In addition, both treatments provide more kinetic energy to the distal carotid siphon artery, especially the stenting model.
The carotid web can significantly influence the flow environments in the carotid artery. Both endarterectomy and stenting treatments could significantly diminish the side effects of the web and are feasible choices for web patients in terms of hemodynamics. Besides, the treatments for the carotid web would also influence the flow patterns at the distal carotid siphon, especially for the stenting treatment. But more innovational designs are needed to make the minimally invasive stenting treatment more beneficial.
颈动脉网是颈内动脉内一种薄的、 shelf样的管腔突起，可能通过诱导血流紊乱、血栓形成以及对内皮细胞的异常生物力学刺激而导致颈动脉狭窄和中风。本研究模拟并评估了两种主要治疗方法（内膜切除术和支架置入术）如何影响颈动脉和颈内动脉虹吸段远端的血流动力学环境，旨在为临床治疗的选择提供更多参考。
基于CT图像重建颈动脉网、内膜切除术和支架置入术模型。进行血流模拟，并分析与血栓形成和动脉重塑相关的关键参数，包括涡旋强度、壁面切应力（WSS）、涡量Q准则和振荡切变指数（OSI）。
在颈动脉网模型中，在网的远端形成明显的回流，同时伴有较低的速度、较低的WSS、较高的相对停留时间（RRT）和较高的Q值。而在两种治疗模型中，颈动脉分叉处的速度增加，Q值和RRT降低。此外，两种治疗方法都为颈内动脉虹吸段远端提供了更多的动能，尤其是支架置入术模型。
颈动脉网可显著影响颈动脉内的血流环境。内膜切除术和支架置入术均可显著减轻颈动脉网的副作用，从血流动力学角度来看，是颈动脉网患者的可行选择。此外，颈动脉网的治疗也会影响颈内动脉虹吸段远端的血流模式，尤其是支架置入术治疗。但需要更多创新设计以使微创支架置入术更有益。
