Bonura Adriano, Musotto Giulio, Iaccarino Gianmarco, Rossi Sergio Soeren, Calandrelli Rosalinda, Capone Fioravante, Di Lazzaro Vincenzo, Pilato Fabio
Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Front Neurol. 2024 Sep 30;15:1455989. doi: 10.3389/fneur.2024.1455989. eCollection 2024.
Arterial dissection, a condition marked by the tearing of the carotid artery's inner layers, can result in varied clinical outcomes, including progression, stability, or spontaneous regression. Understanding these outcomes' underlying mechanisms is crucial for enhancing patient care, particularly with the increasing use of computer simulations in medical diagnostics and treatment planning. The aim of this study is to utilize computational analysis of blood flow and vascular wall to: (1) understand the pathophysiology of stroke-like episodes in patients with carotid artery dissection; and (2) assess the effectiveness of this method in predicting the evolution of carotid dissection.
Utilizing contrast-enhanced magnetic resonance angiography (MRA), we segmented images of the patient's right internal carotid artery. These images were transformed into 3D solids for simulation in Ansys multifisic software, employing a two-way fluid structure interaction (FSI) analysis. Simulations were conducted across two wall conditions (atherosclerotic and normal) and three pressure states (hypotension, normotension, hypertension).
The simulations indicated a significant pressure discrepancy between the true and false lumens of the artery. This suggests that flap motion and functional occlusion under hypertensive conditions could be the cause of the clinical episodes. Thrombotic risk and potential for dissection extension were not found to be critical concerns. However, a non-negligible risk of vessel dilation was assessed, aligning with the patient's clinical follow-up data.
This study highlights specific hemodynamic parameters that could elucidate carotid artery dissection's mechanisms, offering a potential predictive tool for assessing dissection progression and informing personalized patient care strategies.
动脉夹层是一种以颈动脉内层撕裂为特征的疾病，可导致多种临床结果，包括进展、稳定或自发消退。了解这些结果的潜在机制对于改善患者护理至关重要，特别是随着计算机模拟在医学诊断和治疗计划中的使用日益增加。本研究的目的是利用血流和血管壁的计算分析来：（1）了解颈动脉夹层患者中风样发作的病理生理学；（2）评估该方法在预测颈动脉夹层演变方面的有效性。
利用对比增强磁共振血管造影（MRA），我们对患者右颈内动脉的图像进行了分割。这些图像被转换为三维实体，以便在Ansys多物理场软件中进行模拟，采用双向流固耦合（FSI）分析。在两种血管壁条件（动脉粥样硬化和正常）和三种压力状态（低血压、正常血压、高血压）下进行模拟。
模拟结果表明动脉真腔和假腔之间存在显著的压力差异。这表明高血压条件下的瓣片运动和功能性闭塞可能是临床发作的原因。未发现血栓形成风险和夹层扩展的可能性是关键问题。然而，评估了不可忽视的血管扩张风险，这与患者的临床随访数据一致。
本研究突出了一些特定的血流动力学参数，这些参数可以阐明颈动脉夹层的机制，为评估夹层进展提供了一种潜在的预测工具，并为个性化的患者护理策略提供依据。
