Luisi Claudio A, Nikoubashman Omid, Steinseifer Ulrich, Wiesmann Martin, Neidlin Michael
Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Clinic for Diagnostic and Interventional Neuroradiology, Medical Faculty, RWTH Aachen University, Aachen, Germany.
Front Bioeng Biotechnol. 2024 Jul 17;12:1421714. doi: 10.3389/fbioe.2024.1421714. eCollection 2024.
Acute ischemic stroke caused by large vessel occlusions is being increasingly treated with neurovascular interventions. The hemodynamics within the collateral system of the circle of Willis (CoW) hemodynamics play a fundamental role in therapy success. However, transient data on pathological collateral flow during large vessel occlusions are not available. Moreover, there are no flow models that accurately simulate the hemodynamic conditions in the CoW during large vessel occlusions. We used a circulatory loop to generate highly reproducible cerebrovascular-like flows and pressures and used non-invasive flow visualization and high-resolution flow and pressure measurements to acquire detailed, time-dependent hemodynamics inside an anatomical phantom of the CoW. After calibrating a physiological reference case, we induced occlusions in the 1. middle cerebral artery, 2. terminal carotid artery, and 3. basilar artery; and measured the left posterior communicating artery flow. Mean arterial pressure and pulse pressure remained unchanged in the different occlusion cases compared to the physiological reference case, while total cerebral flow decreased by up to 19%. In all three occlusion cases, reversed flow was found in the left posterior communicating artery compared to the reference case with different flow magnitudes and pulsatility index values. The experimental results were compared with clinical findings, demonstrating the capability of this realistic cerebrovascular flow setup. This novel cerebrovascular flow setup opens the possibility for investigating different topics of neurovascular interventions under various clinical conditions in controlled preclinical laboratory studies.
大血管闭塞所致急性缺血性卒中越来越多地采用神经血管介入治疗。 Willis 环（CoW）侧支循环系统内的血流动力学在治疗成功中起着至关重要的作用。然而，关于大血管闭塞期间病理性侧支血流的瞬时数据尚无可用。此外，也没有能够准确模拟大血管闭塞期间CoW血流动力学状况的血流模型。我们使用一个循环回路来生成高度可重复的脑血管样血流和压力，并使用非侵入性血流可视化以及高分辨率血流和压力测量来获取CoW解剖模型内详细的、随时间变化的血流动力学数据。在校准一个生理参考病例后，我们分别在1. 大脑中动脉、2. 颈内动脉末端和3. 基底动脉处诱导闭塞，并测量左后交通动脉的血流。与生理参考病例相比，不同闭塞病例中的平均动脉压和脉压保持不变，而全脑血流量最多减少了19%。在所有三种闭塞病例中，与参考病例相比，左后交通动脉均出现反向血流，且血流大小和搏动指数值各不相同。将实验结果与临床发现进行比较，证明了这种逼真的脑血管血流设置的能力。这种新型脑血管血流设置为在可控的临床前实验室研究中，研究各种临床条件下神经血管介入的不同课题开辟了可能性。
