基于计算流体力学仿真模型对颈内动脉狭窄不同手术方式的疗效分析

doi:10.19854/j.cnki.1008-2425.2025.02.0007

立体定向和功能性神经外科杂志 ›› 2025, Vol. 38 ›› Issue (2): 107-112.DOI: 10.19854/j.cnki.1008-2425.2025.02.0007

基于计算流体力学仿真模型对颈内动脉狭窄不同手术方式的疗效分析

张超, 周星辰, 赵彪, 陈彪, 巢青, 王大巍

233000 蚌埠蚌埠医科大学第二附属医院神经外科

收稿日期:2025-02-12 出版日期:2025-04-25 发布日期:2025-06-24
通讯作者: 王大巍 15841439542@163.com
基金资助:
安徽省高校自然科学研究重点项目(编号:2023AH052015)

Effect analysis of different surgical methods for internal carotid artery stenosis based on computational fluid dynamics simulation modeling

Zhang Chao, Zhou Xingchen, Zhao Biao, Chen Biao, Chao Qing, Wang Dawei

Department of Neurosurgery,The Second Affiliated Hospital Of Bengbu Medical University,Bengbu,233000,China

Received:2025-02-12 Online:2025-04-25 Published:2025-06-24
Contact: Wang Dawei 15841439542@163.com

摘要/Abstract

摘要： 目的基于头颈部CTA影像数据建立计算流体力学仿真模型,研究颈内动脉狭窄处的血流动力学特点对颈内动脉狭窄不同手术方式的影响。方法回顾性分析蚌埠医科大学第二附属医院 2021年01月至2023年12月间行颈内动脉狭窄手术的40例患者,其中颈动脉支架置入术组(CAS组,n=20)和颈动脉内膜剥脱术组(CEA组,n=20),运用脑血管三维重建技术对颈动脉及颈内动脉进行3D模型重建,并进行血流动力学参数分析两组治疗方式的差异性。结果两组患者术前狭窄血管血流动力学指标并无明显差异。在术后方面:CEA组术后狭窄相对滞留时间为 3.90 (3.32,4.36),较CAS组的2.42(1.92,3.15)显著增加(P＜0.001);CEA组术后狭窄血管时间平均壁面剪切应力(pa/mm)为1.11 (0.64,1.47),显著低于CAS组的1.50 (1.13,1.95)(P=0.02);CEA组术后狭窄血管速度(m/s)为0.17 (0.11,0.21),低于CAS组的0.26 (0.17,0.34)(P=0.017);CEA组在住院总费用(33892.81 ± 11129.68元)方面较CAS组(69261.86 ± 17083.07元)有明显优势(P＜0.001)。但是CAS组的住院时间为11.50 (10.75,15.00) 天,较CEA组的14.00 (12.75,20.00)天有显著优势(P=0.047)。两组患者术后1月内均无卒中或死亡发生。结论基于计算流体力学仿真模型分析,CEA较CAS不仅在血流动力学参数改善上有明显优势,其短期神经功能改善也优于CAS。

关键词: 颈内动脉狭窄, CT 血管造影, 计算流体力学, 颈动脉内膜剥脱术, 颈动脉支架置入术

Abstract: Objective A computational fluid dynamics simulation model was established based on the CTA image data of the head and neck to study the influence of the hemodynamic characteristics at the site of internal carotid artery stenosis on different surgical methods of internal carotid artery stenosis. Methods Forty patients who underwent internal carotid artery stenosis surgery in the Second Affiliated Hospital of Bengbu Medical University between January 2021 and December 2023 were retrospectively analyzed and divided into the carotid artery stent implantation group (CAS group,n=20) and the carotid endarterectomy group (CEA group,n=20) according to the treatment modalities.Three-dimensional (3D) reconstruction of carotid arteries and ICA was performed using cerebrovascular imaging techniques,followed by hemodynamic parameter analysis to compare outcomes between the two groups. Results Preoperative hemodynamic parameters at stenosis sites showed no significant differences between the two groups.In the postoperative period:relative residence time?(RRT) in the CEA group was 3.90 (3.32,4.36),which was significantly higher than that of the CAS group 2.42 (1.92,3.15) (P＜0.001); stenotic vessel time-averagewall shear stress (TAWSS) (pa/mm) in the CEA group was 1.11 (0.64,1.47),which was lower than that of the CAS group 1.50 (1.13,1.95) (P=0.02); stenotic vessel velocity (m/s) in the CEA group was 0.17(0.11,0.21),which was lower than that of the CAS group 0.26 (0.17,0.34) (P=0.017).The CEA group had a lower total cost of hospitalization (33892.81± 11129.68 CNY) than patients in the CAS group (69261.86± 17,083.07 CNY) (P＜0.001).However,the duration of hospitalization (days) in the CEA group 14.00(12.75,20.00) was longer than that of the patients in the CAS group 11.50(10.75,15.00) (P=0.047).There were no strokes or deaths within 1 month postoperatively in either group. Conclusion Computational fluid dynamics simulation model analysis demonstrated that CEA outperformed CAS in improving hemodynamic parameters and exhibited superior short-term neurological outcomes.

Key words: Internal carotid artery stenosis, Computed tomography angiography, Computational fluid dynamics, Carotid endarterectomy, Carotid artery stenting

中图分类号:

R743

张超, 周星辰, 赵彪, 陈彪, 巢青, 王大巍. 基于计算流体力学仿真模型对颈内动脉狭窄不同手术方式的疗效分析[J]. 立体定向和功能性神经外科杂志, 2025, 38(2): 107-112.

Zhang Chao, Zhou Xingchen, Zhao Biao, Chen Biao, Chao Qing, Wang Dawei. Effect analysis of different surgical methods for internal carotid artery stenosis based on computational fluid dynamics simulation modeling[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2025, 38(2): 107-112.

参考文献

[1] Musialek P,Rosenfield K,Siddiqui AH,et al.Carotid stenosis and stroke:medicines,stents,surgery-“wait-and-see” or protect[J].Thromb Haemost,2024,124(9):815~827.
[2] Lanzino G,Tallarita T,Rabinstein AA.Internal carotid artery stenosis:natural history and management[J].Semin Neurol,2010,30(5):518-527.
[3] Feigin VL,Lawes CM,Bennett DA,et al.Worldwide stroke incidence and early case fatality reported in 56 population-based studies:a systematic review[J].Lancet Neurol,2009,8(4):355~369.
[4] Bir SC,Kelley RE.Carotid atherosclerotic disease:a systematic review of pathogenesis and management[J].Brain Circ,2022,8(3):127~136.
[5] Rerkasem A,Orrapin S,Howard DP,et al.Local versus general anaesthesia for carotid endarterectomy[J].Cochrane Database Syst Rev,2021,10(10):CD000126.
[6] Chihara H,Maki Y,Hatano T.An extremely rare complication during carotid artery stenting using a Wallstent:Migration of a stent holder of a Carotid Wallstent[J].Neuroradiol J,2024:19714009241260799.
[7] Liu YS,Jiang GN,Wang XW,et al.The relationship between geometry and hemodynamics of the stenotic carotid artery based on computational fluid dynamics[J].Clin Neurol Neurosurg,2023,231:107860.
[8] Dinh H,Vinuela F,Szeder V,et al.Reconstruction of carotid stenosis hemodynamics based on guidewire pressure data and computational modeling[J].Med Biol Eng Comput,2022,60(5):1253~1268.
[9] Pavlin-Premrl D,Boopathy SR,Nemes A,et al.Computational fluid dynamics in intracranial atherosclerosis - lessons from cardiology:a review of CFD in intracranial atherosclerosis[J].J Stroke Cerebrovasc Dis,2021,30(10):106009.
[10] 孙玉玺,程哲,陈硕硕,等.基于CTA数据后处理对颈内动脉狭窄处血流动力学特点的研究[J].中国实用神经疾病杂志,2024,27(5):547~551.
[11] Alagoz AN,Acar BA,Acar T,et al.Relationship between carotid stenosis and infarct volume in ischemic stroke patients[J].Med Sci Monit,2016,22:4954~4959.
[12] Saxena A,Ng EYK,Lim ST.Imaging modalities to diagnose carotid artery stenosis:progress and prospect[J].Biomed Eng Online,2019,18(1):66.
[13] Eastcott HH,Pickering GW,Rob CG.Reconstruction of internal carotid artery in a patient with intermittent attacks of hemiplegia[J].Lancet,1954,267(6846):994~996.
[14] Kerber CW,Cromwell LD,Loehden OL.Catheter dilatation of proximal carotid stenosis during distal bifurcation endarterectomy[J].AJNR Am J Neuroradiol,1980,1(4):348~349.
[15] 吴强,杨金凤,朱城伊.颈动脉支架植入术在颈动脉狭窄性缺血性脑血管病治疗中的临床效果分析[J].基层医学论坛,2024,28(35):52~55.
[16] Palaiodimou L.Transcarotid artery revascularization expanding our arsenal for the management of symptomatic carotid artery stenosis[J].Stroke,2024,55(4):931~933.
[17] Woronowicz K,Krasiński Z,Łukawiecki S,et al.Internal carotid artery stenosis - angioplasty with stenting or endarterectomy A restrospective,single-center,observational study[J].Pol Przegl Chir,2024,96(6):63~69.
[18] Kashiwazaki D,Hori E,Akioka N,et al.Clinical significance of carotid endarterectomy and carotid artery stenting in older patients over 80[J].Neurol Med Chir (Tokyo),2024,64(4):147~153.
[19] 武倡臣,穆德勇,刘昱甫,等.颈动脉内膜切除术与颈动脉支架置入术对颈动脉狭窄治疗效果的单中心临床研究[J].空军军医大学学报,2025,46(2):198~204.
[20] Hashemi J,Patel B,Chatzizisis YS,et al.Study of coronary atherosclerosis using blood residence time[J].Front Physiol,2021,12:625420.
[21] Calò K,De Nisco G,Gallo D,et al.Exploring wall shear stress spatiotemporal heterogeneity in coronary arteries combining correlation-based analysis and complex networks with computational hemodynamics[J].Proc Inst Mech Eng H,2020,234(11):1209~1222.
[22] Chen Z,Qin H,Liu J,et al.Characteristics of wall shear stress and pressure of intracranial atherosclerosis analyzed by a computational fluid dynamics model:a pilot study[J].Front Neurol,2019,10:1372.
[23] Tao XY,Chen YP,Huang W,et al.Evaluafion of the efficacy of wall shear stress in carotid artery stenting[J].Heliyon,2024,10(11):e31383.
[24] Malik J,Novakova L,Valerianova A,et al.Wall shear stress alteration:a local risk factor of atherosclerosis[J].Curr Atheroscler Rep,2022,24(3):143~151.
[25] Zhang X,Jiao Z,Hua ZH,et al.Localized elevation of wall shear stress is linked to recent symptoms in patients with carotid stenosis[J].Cerebrovasc Dis,2023,52(3):283~292.
[26] Dai YY,Qian Y,Zhang MZ,et al.Associations between local haemodynamics and carotid intraplaque haemorrhage with different stenosis severities:a preliminary study based on MRI and CFD[J].J Clin Neurosci,2019,66:220~225.
[27] Ren SQ,Liu QJ,Chen ZS,et al.Hemodynamic evaluation of endarterectomy and stenting treatments for carotid web[J].Front Cardiovasc Med,2022,9:993037.

基于计算流体力学仿真模型对颈内动脉狭窄不同手术方式的疗效分析

Effect analysis of different surgical methods for internal carotid artery stenosis based on computational fluid dynamics simulation modeling

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