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

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