目的:本研究的目的是探讨前循环动脉侧壁和分叉部动脉瘤的形态和血流动力学特征的差异和相关性。利用计算流体动力学作为分析工具。
方法:根据指定的纳入标准,这项研究涵盖了在同济医学院附属协和医院接受治疗的131名患者中发现的160个动脉瘤,华中科技大学,中国,从2021年1月到2022年9月。利用后续数字减影血管造影(DSA)数据,这些病例分为两个不同的组:侧壁动脉瘤组和分叉动脉瘤组。术前即刻的形态学和血流动力学参数经过精心计算,并使用三维DSA重建模型对两组进行检查。
结果:在前循环的不同位置,分叉动脉瘤的形态或血液动力学参数没有发现显着差异。然而,侧壁和分叉动脉瘤之间在形态学参数方面存在明显差异,例如父血管(Dvane)的直径,流入角(θF),和尺寸比(SR),血流动力学参数流入浓度指数(ICI)(P<0.001)。值得注意的是,只有SR与多个血流动力学参数有显著相关性(P<0.001),ICI与几个形态学参数密切相关(R>0.5,P<0.001)。
结论:侧壁动脉瘤和分叉动脉瘤在某些形态和血流动力学参数上的显著差异强调了在评估前循环动脉瘤破裂风险时考虑这些参数阈值差异的重要性。无论是分叉还是侧壁动脉瘤,应该考虑这些差异。形态学参数SR有可能成为及时区分与侧壁和分叉动脉瘤相关的不同破裂风险的有价值的临床工具。
OBJECTIVE: The objective of this research was to explore the difference and correlation of the morphological and hemodynamic features between
sidewall and bifurcation aneurysms in anterior circulation arteries, utilizing computational fluid dynamics as a tool for analysis.
METHODS: In line with the designated inclusion criteria, this study covered 160 aneurysms identified in 131 patients who received treatment at Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, China, from January 2021 to September 2022. Utilizing follow-up digital subtraction angiography (DSA) data, these cases were classified into two distinct groups: the
sidewall aneurysm group and the bifurcation aneurysm group. Morphological and hemodynamic parameters in the immediate preoperative period were meticulously calculated and examined in both groups using a three-dimensional DSA reconstruction model.
RESULTS: No significant differences were found in the morphological or hemodynamic parameters of bifurcation aneurysms at varied locations within the anterior circulation. However, pronounced differences were identified between
sidewall and bifurcation aneurysms in terms of morphological parameters such as the diameter of the parent vessel (Dvessel), inflow angle (θF), and size ratio (SR), as well as the hemodynamic parameter of inflow concentration index (ICI) (P<0.001). Notably, only the SR exhibited a significant correlation with multiple hemodynamic parameters (P<0.001), while the ICI was closely related to several morphological parameters (R>0.5, P<0.001).
CONCLUSIONS: The significant differences in certain morphological and hemodynamic parameters between sidewall and bifurcation aneurysms emphasize the importance to contemplate variances in threshold values for these parameters when evaluating the risk of rupture in anterior circulation aneurysms. Whether it is a bifurcation or
sidewall aneurysm, these disparities should be considered. The morphological parameter SR has the potential to be a valuable clinical tool for promptly distinguishing the distinct rupture risks associated with
sidewall and bifurcation aneurysms.