北京生物医学工程

分叉和狭窄对颅内动脉血液流体动力学的影响

Effects of bifurcation and stenosis on hemodynamics of intracranial artery

作者：严妤函刘瑜许波郭蕾陈阳希黄方钱晓明万文辉

单位：东部战区总医院干部病房一科(南京210002)  东南大学能源与环境学院(南京210096) 通信作者:万文辉。E-mial: wanwhnj@sina. com

关键词：动脉粥样硬化;颅内动脉狭窄;分叉角度;计算流体动力学;剪切力;压强;速度

分类号：R318. 01

出版年·卷·期（页码）：2021·40·6（584-590）

摘要：

目的基于颅内动脉数量众多且影响因素较多，本文重点研究了分叉角度、对称分支动脉狭窄度、不对称分支动脉狭窄度和斑块尺寸对颅内动脉粥样硬化形成和生长的影响作用，以期利用血流动力学参数的评估为动脉粥样硬化的预警、诊断及选择合适的血管内治疗等提供一定的指导作用。方法基于计算流体动力学方法，构建主支动脉连接分支动脉的几何模型和有限元模型的边界条件，设计 45°-135°区间共7种分叉角度，依托狭窄度'来表征血管的狭窄程度,通过血液压力、流速和剪切力等血液流体力学参数对比分析各因素对颅内动脉粥样硬化的产生及发展过程的机制。结果分叉角度对速度比最大值和剪切力最大值基本没有影响，对压力最小值影响也较小，最大振幅不超过5%。随着狭窄度的增加,最小压力下降而速度比最大值增加，当X从0增加到0. 5、0. 67和0. 75时,最小压力分别下降了 1. 6 Pa、l. 8 Pa和3. 6 Pa,速度比最大值分别上升了 48%、1. 2倍和1. 9倍;狭窄度对最大剪切力的影响很小,直到当狭窄度增大到0.75时，最大剪切力提升了 5%。非对称两个支路狭窄度的比值Q增加时,3个参数均逐渐增加且增加的幅度随甲的增加而增大。随着斑块长度的增加，压力最小值呈线性增加，速度比最大值则逐渐增加，剪切力最大值则是逐渐下降,最后趋势趋于平缓。结论分叉角度对血液流体力学参数的影响较小;对称分支动脉狭窄度越大，或者不对称分支动脉的狭窄度比值越大，或者斑块长度越短，均引起血管壁剪切力越大，越容易造成血管内壁损伤，加速动脉粥样硬化。本研究为颅内动脉粥样硬化的形成机制、影响因素以及预测转归等方面提供有用信息。

Objective Based on the numerous numbers of intracranial artery and more influencing factors, this paper focused on the influence of bifurcation angle, stenosis degree of symmetric branch artery, stenosis degree of asymmetric branch artery and plaque size on the formation and growth of intracranial atherosclerosis, providing a certain guiding role for early warning, diagnosis and selection of appropriate endovascular treatment for atherosclerosis by evaluation of hemodynamic parameters. Methods Based on the computational fluid dynamics method, the geometric model of connection between main and branch arteries and the boundary conditions of finite element model are constructed. A total of seven bifurcation angles are designed among 45° and 135° ,and the stenosis degree is characterized by X. The formation and development mechanism of intracranial atherosclerosis induced by various factors are analyzed by comparing the hemodynamic parameters such as blood pressure, flow rate and shear force. Results The bifurcation angle has little effect on the maximum velocity ratio and maximum shear force, but little effect on the minimum pressure with maximum amplitude of less than 5%. When X increases from 0 to 0. 5,0. 67 and 0. 75, the minimum pressure decreases by 1. 6 Pa, 1. 8 Pa and 3. 6 Pa, and the maximum velocity ratio increases by 48%, 1. 2 times and 1. 9 times,respectively. The effect of stenosis degree on maximum shear force is small, while the maximum shear force increases 5% in the stenosis degree of 0. 75 than that of 0. With the increase of ratio of two asymmetric branches narrowness (<p) ,all three parameters gradually increase. In addition, the larger <p leads greater increase amplitude. With the increase of patch length, the minimum value of pressure increases linearly, the maximum velocity ratio gradually increases and then tends to be flat, and the maximum value of shear force gradually decreases and then also tends to be flat. Conclusions The present study shows that the bifurcation angle has little effect on the hemodynamic parameters. The greater stenosis degree of symmetric branch artery and the ratio of stenosis degree of asymmetric branch artery, or the shorter plaque length cause larger haemal wall shear stress, which is more likely to cause the damage of blood vessels and accelerate atherosclerosis. This paper provides useful information for formation mechanism, influencing factors and predicting outcome of intracranial atherosclerosis.

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