北京生物医学工程

密网支架治疗颅内分叉动脉瘤数值模拟研究

Numerical simulation of intervention for cerebral bifurcate aneurysm by dense braided stent

作者：付文宇李立新任鹏飞乔爱科

单位：北京联合大学机器人学院( 北京 100027) 北京工业大学生命学院（北京100124）

关键词：编织支架; 颅内分叉动脉瘤; 壁面切应力; 血流速度

分类号：R318.04

出版年·卷·期（页码）：2020·39·6（561-568）

摘要：

目的对密网支架虚拟植入颅内分叉动脉瘤过程进行数值模拟研究，探讨植入密网支架对颅内分叉动脉瘤腔的血流动力学的影响，为密网支架是否适合介入治疗颅内分叉动脉瘤进行初步的力学计算研究。方法利用有限元软件ABAQUS模拟密网支架植入颅内分叉动脉瘤的过程，得到变形后的支架模型。在ANSYS CFX中对颅内分叉动脉瘤模型及植入密网支架的分叉动脉瘤模型进行流体计算，比较植入支架前后动脉瘤腔中流线变化情况、瘤腔中血流平均速度值，动脉瘤壁面压力及壁面切应力变化情况。结果支架-微导管模型可以很好地模拟植入全过程。特别发现在载瘤动脉局部支架和血管壁贴合不良; 植入支架后动脉瘤腔平均血流速度在收缩期加速和减速阶段分别降低了71.4%和17.2%；植入支架后动脉瘤面切应力降低了，但壁面压力略有增加。结论密网支架可降低颅内分叉动脉瘤腔血流速度，但需特别关注密网支架和载瘤动脉局部贴合不良问题，其有可能导致载瘤动脉狭窄。

Objective The numerical simulation of the process that the braided stent is virtually implanted into the intracranial bifurcation aneurysm is carried out. The hemodynamics of the aneurismal cavity before and after the implantation of the braided stent are compared. A preliminary study of mechanical calculation is carried out whether the dense stent is suitable for interventional treatment of cerebral bifurcate aneurysm. Methods The finite element software ABAQUS is used to simulate the process of implanting dense braided stent into intracranial bifurcation aneurysm and obtaining stent model which is implanted into parent artery. ANSYS CFX is used to perform fluid calculations on the intracranial bifurcation aneurysm model and the bifurcate aneurismal model which is implanted with dense braided stent. The changes of streamlines and the average speed of blood flow in the aneurismal cavity before and after the stent implantation, and the changes of the pressure and the wall shear stress on aneurismal wall were compared. Results The whole implantation process of the stent-microcatheter model is well simulated. In particular, poor apposition between stent and vessel walls are found in parent artery locally. After the braided stent implantation, the mean blood flow speed in the aneurismal cavity decreased by 71.4% and 17.2% during the systolic acceleration and deceleration phases, respectively. After the implantation of the braided stent, the aneurismal wall shear stress is reduced, but the wall pressure increases slightly. Conclusions The dense braided stent can reduce the blood flow speed in the intracranial bifurcate aneurismal cavity. Special attention needs to be paid to the poor apposition between the braided stent and the parent artery, which may lead to narrowing of the parent artery.

参考文献：

[1] 付文宇，乔爱科. 5种支架对颈内动脉瘤血液动力学影响的数值研究[J]. 医用生物力学，2010，25(5): 344-351.
Fu WY， Qiao AK. Numerical research of hemodynamics effects on internal carotid aneurysm with five types of stents[J]. Journal of Medical Biomechanics, 2010, 25(5): 344-351.
[2] 王奎重，袁绍纪. 血流导向支架治疗颅内动脉瘤的相关并发症现状[J]. 中华神经医学杂志， 2012 , 11 (5) ：535-537.
Wang KZ, Yuan SJ. Complications of flow diverter in treating intracranial aneurysms[J]. Chinese Journal of Neuromedicine, 2012 , 11 (5)：535-537.
[3] Pumar JM, Lete I, Pardo MI, et al. LEO stent monotherapy for the endovascular reconstruction of fusiform aneurysm of the middle cerebral artery[J]. American Journal of Neuroradiology, 2008, 29(9): 1775-1776.
[4] Cekirge HS, Yavuz K, Geyik S, et al. A novel ‘Y’ stent flow diversion technique for the endovascular treatment of bifurcation aneurysms without endosaccular coiling[J]. American Journal of Neuroradiology, 2011, 32(7): 1262-1268.
[5] 杨鹏飞，刘建民，黄清海,等. 新型血流导向装置Tubridge治疗颅内动脉瘤的初步经验[J]. 介入放射学杂志, 2011，20(5)：357-362.
Yang PF, Liu JM, Huang QH, et al. The use of novel flow diverting device Tubridge for the treatment of intracranial aneurysms： initial experience [J]. Journal of Interventional Radiology, 2011, 20(5): 357-362.
[6] Ma D, Gary FD, Natarajan SK, et al. Computer modeling of deployment and mechanical expansion of neurovascular flow diverter in patient-specific intracranial aneurysms[J]. Journal of Biomechanics, 2012, 45(13): 2256-2263.
[7] Kim JH, Kang TJ, Yu WR. Mechanical modeling of self-expandable stent fabricated using braiding technology[J]. Journal of Biomechanics, 2008, 41(15): 3202-3212.
[8] 刘元早，王霖. 大脑中动脉分叉角大小与动脉瘤形成的关系[J]. 重庆医学，2016, 45(7)：929-930, 933.
Liu YZ, Wang L. The relationship of the bifurcation angle size with aneurismal occurrence in the horizontal section of middle cerebral artery [J]. Chongqing Medicine,2016,45(7): 929-930, 933.
[9] Fu WY, Xia QX. Interaction between flow diverter and parent artery of intracranial aneurysm: a computational study[J]. Applied Bionics and Biomechanics, 2017, 2017: 3751202.
[10] Fu WY, Cheng G, Yan RB, et al. Numerical investigations of the flexibility of intravascular braided stent[J]. Journal of Mechanics in Medicine and Biology, 2017, 17(4): 1750075.
[11] Janiga G, Berg P, Sugiyama S, et al. The computational fluid dynamics rupture challenge 2013—phase I: prediction of rupture status in intracranial aneurysms [J]. American Journal of Neuroradiology, 2015, 36(3): 530-536.
[12] Boussel L, Rayz V, McCulloch C, et al. Aneurysm growth occurs at region of low wall shear stress: patient-specific correlation of hemodynamics and growth in a longitudinal study[J]. Stroke, 2008, 39(11): 2997-3002.
[13] Malek AM, Alper SL, Izumo S. Hemodynamic shear stress and its role in atherosclerosis[J]. The Journal of the American Medical Association, 1999, 282(21): 2035-2042.
[14] Fu WY, Gu ZY, Meng XL, et al. Numerical simulation of hemodynamics in stented internal carotid aneurysm based on
patient-specific model[J]. Journal of Biomechanics, 2010, 43(7): 1337-1342.
[15] Steinman DA, Hoi Y, Fahy P, et al. Variability of computational fluid dynamics solutions for pressure and flow in a giant aneurysm: the ASME 2012 Summer Bioengineering Conference CFD challenge[J]. Journal of Biomechanical Engineering, 2013,135(2): 021016.

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