血流导向装置与弹簧圈联合治疗巨型颅内动脉瘤的数值模拟研究现状

Research status on numerical simulation of giant intracranial aneurysms treated by flow diverter and coil

血管内弹簧圈(coil)栓塞治疗因创伤小、恢复快等优点成为目前普遍应用的颅内动脉瘤治疗手段。近年来血流导向装置(flow diverter,FD)作为颅内动脉瘤血管内治疗技术的重大突破,主要体现为从动脉瘤囊内填塞到载瘤动脉重塑治疗理念的转变,为巨型颅内动脉瘤的治疗带来了全新的方法。文章首先介绍了FD与弹簧圈的数值模拟方法,然后列出常见的影响动脉瘤治疗效果的形态学与血流动力学参数,详细说明了FD孔率、弹簧圈填塞率与壁面切应力对改善瘤囊内血流动力学的重要作用,最后结合FD与弹簧圈治疗颅内动脉瘤的特征,通过数值模拟的方法对比了二者的治疗效果。结果显示使用FD治疗巨型颅内动脉瘤具有一定的优越性,但更多的研究表明FD联合疏松弹簧圈栓塞治疗时,动脉瘤的延迟破裂率与复发率更低。结论进一步说明了FD与弹簧圈栓塞巨型颅内动脉瘤的发展方向。

Intravascular coil embolization therapy has been widely used for intracranial aneurysms due to its fewer traumas and rapid recuperation.In recent years,flow diverter,as a major breakthrough in endovascular treatment of intracranial aneurysm,mainly manifests as a transformation of ideas from aneurysm capsule embolization to reconstruction of the parent artery.This technology brings a new approach to the treatment of giant intracranial aneurysms.Firstly,this article introduced the numerical simulation methods of flow diverter and coil,lists the morphological and hemodynamic parameters which affected the curative effect of aneurysms.Then,the important roles of porosity of flow diverter,packing density of coil and wall shear stress on improving hemodynamics in tumor sac were described in detail.Finally,the feature comparison between FD and coil for intracranial aneurysm therapy was done by numerical simulation in accompany with analyzing the treatment effects of flow diverter and coil.The results showed that the choice of flow diverter had certain superiority for giant intracranial aneurysms,however more studies concluded that the delayed rupture rate and recurrence rate of aneurysms might be lower when the loosing coil embolization was taken into account with flow diverter technology.Furthermore,the conclusion made afurther explanation of the developing direction of giant intracranial aneurysms treated with flow diverter and coil embolization.