Department of Vascular Surgery, the Second Affiliated Hospital of Zhejiang University's Medical College, Hangzhou 310051, China.
Department of Simulation Science and Technology, Shaanxi Xinmai Medical Technology Co., Ltd, Xi'an 710000, China.
Int J Cardiol. 2024 Dec 15;417:132494. doi: 10.1016/j.ijcard.2024.132494. Epub 2024 Sep 7.
False lumen (FL) thrombosis status for Stanford type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR) is critical for evaluating aortic remodeling and long-term prognosis. This study aimed to monitor the morphology evolution of partial FL thrombosis (PFLT) and its hemodynamic conditions through an innovative approach, providing a re-intervention strategy from both morphologic and hemodynamic perspectives.
Three-dimensional geometries are extracted from a five-year follow-up of CTA images for TBAD after TEVAR. The morphology and hemodynamics of PFLT are comprehensively analyzed based on patient-specific reconstructions and computational fluid dynamics (CFD). The impact of various strategies treating risk factors of PFLT, including proximal entry closure, left renal artery stenting, or accessory renal artery embolism on hemodynamics is assessed.
The introduced morphologic approaches appropriately reflected the evolution of PFLT. Gradual dilation of FL (surface area from 82.63cm to 98.84cm, volume from 45.12 mL to 63.40 mL, increase in distal tear (from 3.72 cm to 4.32 cm), and fluctuation of thrombosis-blood lumen boundary are observed. For further surgical preparation in the absence of unanimously recognized re-intervention indicators, velocity and wall shear stress distributions reveal different simulated re-interventions have distinctly suppressive effects on hemodynamic conditions within the PFLT, providing valuable insights for further surgical preparation.
The present study demonstrates a re-intervention strategy for PFLT in TBAD patients after TEVAR utilizing morphologic and hemodynamic analyses. Acknowledging the deterioration of PFLT may result in adverse long-term outcomes, this strategy might offer an alternative approach for clinical monitoring and management of related patients.
胸主动脉腔内修复术（TEVAR）治疗Stanford B 型主动脉夹层（TBAD）后假腔（FL）血栓状态对评估主动脉重塑和长期预后至关重要。本研究旨在通过一种创新方法监测部分 FL 血栓（PFLT）的形态演变及其血流动力学状况，从形态和血流动力学两个角度提供一种再干预策略。
从 TEVAR 治疗后 TBAD 的 CTA 图像五年随访中提取三维几何形状。基于患者特异性重建和计算流体动力学（CFD）对 PFLT 的形态和血流动力学进行全面分析。评估治疗 PFLT 危险因素的各种策略（包括近端入口闭合、左肾动脉支架置入或副肾动脉栓塞）对血流动力学的影响。
所提出的形态方法适当地反映了 PFLT 的演变。FL 逐渐扩张（表面积从 82.63cm 增加到 98.84cm，体积从 45.12mL 增加到 63.40mL，远端撕裂增加（从 3.72cm 增加到 4.32cm），血栓-血流腔边界波动。对于没有公认的再干预指标的进一步手术准备，速度和壁面剪切应力分布显示，不同的模拟再干预对 PFLT 内的血流动力学条件具有明显的抑制作用，为进一步的手术准备提供了有价值的见解。
本研究利用形态学和血流动力学分析，为 TEVAR 治疗后的 TBAD 患者 PFLT 提供了一种再干预策略。认识到 PFLT 的恶化可能导致不良的长期结局，该策略可能为相关患者的临床监测和管理提供一种替代方法。
