摘要
目的探讨术前采用计算流体动力学(computational fluid dynamics,CFD)优化血流动力学在血流导向装置(flow diverter,FD)治疗椎基底动脉夹层动脉瘤(vertebrobasilar dissecting aneurysm,VBDA)中的有效性和安全性。方法26例VBDA患者均行FD置入治疗,术前行全脑数字减影血管造影(digital subtraction angiography,DSA)检查,采集动脉瘤瘤腔和载瘤动脉处DICOM格式数据,采用CFD数值模拟技术分析不同手术方案血流动力学参数壁面剪切力、流速、流速等值面,评估术后血流动力学改变情况,制定最佳手术方案。术后即刻行DSA检查评价瘤腔及载瘤动脉血流情况,记录术中及术后并发症发生情况。随访3个月~1年,观察动脉瘤破裂、脑出血等发生情况,行改良Rankin评分及DSA检查评估预后情况。结果26例VBDA患者均按照CFD制定的手术方案进行手术,单纯FD置入17例,FD置入结合弹簧圈栓塞9例,其中动脉瘤致密栓塞2例,非致密栓塞7例。术后即刻DSA检查示24个动脉瘤明显造影剂滞留,2个动脉瘤未显影。2例发生术后并发症,其中1例发生皮质盲,1例发生脑桥穿支动脉梗死,经治疗后均恢复良好;所有患者术中及术后均未发生动脉瘤破裂、脑出血及支架内血栓形成。26例患者术后随访(6.7±2.4)个月,均未发生动脉瘤破裂、脑出血及神经功能缺损症状。22例行DSA检查,其中治愈2例,好转15例,稳定5例;改良Rankin评分0~2分19例,3~6分3例。结论VBDA患者行FD置入术前采用CFD优化血流动力学、制定合适手术方案,手术治疗的有效性和安全性良好。
Objective To investigate the effectiveness and safety of preoperative computational fluid dynamics(CFD)optimized hemodynamics in flow diverter(FD)for treating vertebrobasilar dissecting aneurysm(VBDA).Methods Twenty-six VBDA patients underwent FD placement,and preoperative whole-brain digital subtraction angiography(DSA)was performed to collect data in DICOM format at the aneurysm lumen and the parent artery.CFD numerical simulation was used to analyze the hemodynamic parameters including wall shear stress,flow velocity and flow velocity isosurface for different surgical options,to assess the postoperative hemodynamic changes and to formulate the optimal surgical plan.The blood flow was evaluated at the aneurysm lumen and the patent artery by DSA immediately after operation.The occurrences of intraoperative and postoperative complications were recorded.All patients were followed up for 3months to 1year,the complications as aneurysm rupture and cerbral hemorrhage were observed and the prognosis was assessed by modified Rankin score and DSA.Results All 26VBDA patients underwent operation according to the CFD protocol,in which 17received FD placement,and 9received FD placement plus spring-ring embolization including 2 receiving dense embolization of aneurysm and 7receiving non-dense embolization.DSA was performed immediately after operation,showing obvious contrast retention in 24aneurysms and no visualization in 2aneurysms.Postoperative complications occurred in 2patients,including 1case of cortical blindness and 1case of infarction in cerebral bridge penetrating artery,and both two patients recovered well after treatment.No aneurysm rupture,cerebral hemorrhage or intra-stent thrombosis occurred during and after operation.No aneurysm rupture,cerebral hemorrhage or neurological deficits occurred in follow-up for(6.7±2.4)months in 26patients.DAS was done in 22patients,showing that 2 patients were cured,15were improved and 5were stable.Modified Rankin score was 0to 2in 19patients,and 3to 6 in 3.Conclusion To apply CFD for optimizing hemodynamics and developing an appropriate surgical plan before FD placement in VBDA patients can achieve a fine effectiveness and safety.
作者
任伟
汪姝
张坤
李钊硕
王子亮
李天晓
高不郎
REN Wei;WANG Shu;ZHANG Kun;LI Zhao-shuo;WANG Zi-liang;LI Tian-xiao;GAO Bu-lang(Department of Medical Imaging,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China;Department of Cerebrovascular Diseases,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)
出处
《中华实用诊断与治疗杂志》
2022年第12期1219-1223,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科技攻关计划省部共建项目(SBGJ202003006)。
