PDF(Pubmed)
Abstract：
Rebleeding from a ruptured intracranial aneurysm has poor outcomes. Although numerous factors are associated with rebleeding, studies on computational fluid dynamics (CFD) on hemodynamic parameters associated with early rebleeding are scarce. In particular, no report of rebleeding in ultra-early phase exists. We aimed to elucidate the specific hemodynamic parameters associated with ultra-early rebleeding using CFD. In this study, the rebleeding group included patients with aneurysmal subarachnoid hemorrhage (aSAH) that rebled within 6 h from the onset. The control group included patients without rebleeding, observed for >10 h following the initial rupture. Clinical images after initial rupture and before rebleeding were used to build 3D vessel models for hemodynamic analysis focusing on the following parameters: time-averaged wall shear stress (WSS), normalized WSS, low shear area, oscillatory shear index, relative residence time, pressure loss coefficient, and aneurysmal inflow rate coefficient (AIRC). Five and 15 patients in the rebleeding and control groups, respectively, met the inclusion criteria. The World Federation of Neurosurgical Surgeons grade was significantly higher in the rebleeding group (p = 0.0088). Hemodynamic analysis showed significantly higher AIRC in the rebleeding group (p = 0.042). The other parameters were not significantly different between groups. There were no significant differences or correlations between SAH severity and AIRC. AIRC was identified as a hemodynamic parameter associated with ultra-early rebleeding of ruptured intracranial aneurysms. Thus, AIRC calculation may enable the prediction of ultra-early rebleeding.
摘要：
颅内动脉瘤破裂引起的再出血预后较差。尽管许多因素与再出血有关，关于与早期再出血相关的血流动力学参数的计算流体力学(CFD)研究很少.特别是,没有超早期再出血的报告.我们旨在使用CFD阐明与超早期再出血相关的特定血液动力学参数。在这项研究中,再出血组包括动脉瘤性蛛网膜下腔出血(aSAH)患者,其在发病后6小时内出现出血.对照组包括没有再出血的患者，在初始破裂后观察到>10小时。首次破裂后和再出血前的临床图像用于建立3D血管模型进行血液动力学分析，重点关注以下参数：时间平均壁切应力（WSS），归一化WSS，低剪切面积,振荡剪切指数，相对停留时间,压力损失系数,和动脉瘤流入率系数（AIRC）。再出血组和对照组分别有5例和15例,分别,符合纳入标准。再出血组的世界神经外科医师联合会评分明显较高(p=0.0088)。血流动力学分析显示，再出血组AIRC显著增高（p=0.042）。其他参数在组间没有显著差异。SAH严重程度与AIRC之间没有显着差异或相关性。AIRC被确定为与颅内动脉瘤破裂的超早期再出血相关的血液动力学参数。因此，AIRC计算可以实现超早期再出血的预测。
