| 李捷,冯学成,黄正威,等.血流导向装置治疗未破裂中小型颈内动脉瘤对血流动力学的影响及短期疗效分析[J].安徽医药,2023,27(3):502-507. |
| 血流导向装置治疗未破裂中小型颈内动脉瘤对血流动力学的影响及短期疗效分析 |
| Effect of flow diverter on hemodynamics and short-term treatment efficacy of unruptured small and medium internal carotid aneurysms |
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| DOI：10.3969/j.issn.1009-6469.2023.03.017 |
| 中文关键词: 颅内动脉瘤 计算机体层摄影血管造影术 自胀式金属内支架 血流导向装置 血流动力学 |
| 英文关键词: Intracranial aneurysm Computed tomography angiography Self expandable metallic stents Flow diverter He?modynamics |
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| 中文摘要: |
| 目的 探讨血流导向装置(flow diverter，FD)治疗未破裂中小型颈内动脉瘤的短期疗效、安全性及治疗后对血流动力学产生的影响。方法 回顾性分析2018年1月至2021年1月在广东医科大学附属医院神经外科应用FD治疗的未破裂中小型颈内动脉瘤(直径≤10 mm)病例32例，并根据术前术后计算机体层血管成像(CTA)对载瘤动脉及动脉瘤的三维重建，进行计算流体力学模拟分析，计算出动脉瘤的瘤内平均壁面应切力(wall shear stress，WSS)，低壁面应切力面积(low wall shear stress ar?ea，LSA)，瘤内相对滞留时间(relative residence time，RRT)等血流动力学参数，同时术前术后均行经颅多普勒超声了解相关的脑血流动力学参数包括，动脉瘤颈处的血流速度，载瘤动脉的血流速度，及双侧大脑中动脉的血流速度等，然后对术前后的血流动力学参数进行对比分析。随访6个月，采用改良Rankin量表(mRS)评分评价病人的预后，采用O’Kelly-Marotta(OKM)分级评估动脉瘤的即刻闭塞程度及6个月随访时的闭塞程度。结果 32例病人共用33个Pipeline支架治疗了35个动脉瘤，手术成功率100%，其中27例病人采用单纯的FD治疗，5例5个动脉瘤结合了弹簧圈栓塞治疗，病人术后的WSS、动脉瘤颈处的血流速度较术前明显降低(P<0.05)，术后的LSA及RRT、载瘤动脉及患侧大脑中动脉的血流速度较术前增加(P<0.05)。术后闭塞程度OKM C级5个(14.3%)，均为结合弹簧圈栓塞的动脉瘤，单纯FD治疗的术后即刻OKM分级 A级21个(60%)，B级9个(25.7%)，6个月随诊时OKM D 级25个(71.4%)，C级6个(17.2%)，B级4个(11.4%)；mRS评分0分30例(93.75%)，1分2例(6.25%)。结论 FD治疗未破裂中小型颈内动脉瘤后血流动力学显示治疗后动脉瘤的WSS、瘤颈的血流速度降低，LSA及RRT的增加与动脉瘤的进一步闭塞有关；载瘤动脉及患侧大脑中动脉的血流速度较术前增加可能与术后载瘤动脉血管顺应性下降有关；术后即刻闭塞率不高，但术后6个月的闭塞率高；手术安全性高，疗效良好，中长期疗效仍需进一步随诊。 |
| 英文摘要: |
| Objective To investigate the short-term efficacy, safety and hemodynamic effect of flow diverter (FD) in the treatment of unruptured small and medium internal carotid aneurysms.Methods Data of 32 cases of unruptured small and medium internal carotid aneurysms (diameter ≤ 10 mm) treated with FD in the Department of Neurosurgery of The Affiliated Hospital of Guangdong Medical University from January 2018 to January 2021 were retrospectively analyzed. Three-dimensional reconstruction was carried out of the parent artery and aneurysm by preoperative and postoperative computed tomographic angiography (CTA), and computational fluid dy?namics simulation analysis was performed to calculate the average wall shear stress (WSS) of the aneurysm, low wall shear stress area(LSA), relative residence time (RRT) and other hemodynamic parameters in the tumor. Meanwhile, transcranial Doppler ultrasound was performed before and after operation to get the relevant cerebral hemodynamic parameters, including the blood flow velocity at the neck of the aneurysm, the blood flow velocity of the parent artery, and the blood flow velocity of bilateral middle cerebral arteries, and then the hemodynamic parameters before and after operation were compared and analyzed. After 6 months of follow-up, the prognosis of pa?tients was evaluated by modified Rankin Scale (mRS), and the degree of immediate occlusion of aneurysms and the degree of occlusion at 6 months of follow-up were evaluated by O'Kelly Marotta (OKM).Results Totally 33 Pipeline stents were used in 32 patients to treat 35 aneurysms, with a success rate of 100%. Among them, 27 patients were treated with simple blood flow guiding device, and 5 pa?tients with 5 aneurysms were treated together with coil embolization. The postoperative WSS and blood flow velocity at the neck of aneu?rysms were significantly lower than those before operation (P<0.05). The postoperative LSA and RRT, the blood flow velocity of the par?ent artery and the affected middle cerebral artery increased compared with those before operation (P<0.05). The degree of occlusion af?ter operation was OKM grade C in 5 (14.3%), all of which were aneurysms embolized with coils. Immediately after FD treatment, OKM grade A was found in 21 (60%) cases, grade B in 9 (25.7%) cases. After 6-month follow-up, OKM grade D was found in 25 (71.4%) cas?es, grade C in 6 (17.2%) cases, and grade B in 4 (11.4%) cases. The mRS score was 0 in 30 (93.75%) cases, 1 in 2 (6.25%) cases.Con?clusions Hemodynamics after the treatment of unruptured small and medium internal carotid aneurysms with FD showed that the blood flow velocity of WSS and neck of aneurysms decreased after treatment, the increase of LSA and RRT was related to the further oc?clusion of aneurysms, and the postoperative increase in blood flow velocity of parent artery and affected middle cerebral artery may be related to the postoperative decrease in vascular compliance of parent artery. The immediate occlusion rate after operation is not high,but the occlusion rate 6 months after operation is high. The operation is safe and effective, but the medium and long-term efficacy still needs further follow-up. |
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