基于血流动力学颈内动脉不同侧别动脉瘤破裂的相关因素分析

Hemodynamics-based analysis of factors associated with aneurysm rupture in different sides of the internal carotid artery

目的探讨血流动力学结合形态学及临床特征对背侧和非背侧颈内动脉瘤(ICAAs)破裂风险的影响。方法回顾性收集2010年1月至2016年12月在徐州医科大学金陵临床学院(东部战区总医院)放射诊断科111例经数字减影血管造影(DSA)或外科手术确诊为动脉瘤并且进行头颅CT血管成像(CTA)检查的患者资料,其中男41例,女70例,年龄32~83(56±11)岁。根据头颅CT平扫或DSA或外科手术的出血表现分为破裂组(n=54)例和未破裂组(n=57)例。收集患者的临床信息及动脉瘤的形态学参数;对2组患者CTA影像进行计算机流体力学分析,获得壁切应力、壁切应力梯度等血流动力学参数。比较破裂/未破裂两组间的参数差异。采用logistic回归分析动脉瘤破裂的独立危险因素,并分别对背侧和非背侧动脉瘤破裂相关的血流动力学特征进行分析。结果与未破裂组相比,破裂组患者年龄较小[(54.2±11.4)岁比(58.3±9.9)岁,P=0.033],女性居多(74.1%比52.6%,P<0.05),有高血压病史患者比例较高(46.3%比22.8%,P=0.009),且破裂动脉瘤多分布于颈内动脉弓背侧处(57.4%比36.8%,P<0.05),血流模式复杂、集中,血流冲击区域小且不稳定(68.5%比33.3%、55.6%比10.5%、72.2%比26.3%及79.6%比36.8%,均P<0.05)。Logistic回归分析显示女性、高血压病史、动脉弓背侧、血流模式(集中的、不稳定的)是颈内动脉瘤破裂的独立危险因素[OR值分别为3.551(1.080~11.679)、3.900(1.172~12.976)、4.966(1.504~16.401)、51.893(7.913~340.296)及50.015(8.423~296.985),均P<0.05]。非背侧动脉瘤破裂组的血流模式更集中、不稳定及冲击区域小(均P<0.05),而背侧处动脉瘤破裂组血流更复杂、集中、不稳定和血流冲击区域更小(均P<0.05)。结论性别、高血压病史、背侧部位、血流集中程度和血流稳定程度是颈内动脉瘤破裂的独立危险因素,位于背侧的颈内动脉瘤破裂风险更高。

Objective To explore the influence of hemodynamics,morphological and clinical characteristics on rupture risk of the dorsal and non-dorsal internal carotid artery aneurysms(ICAAs).Methods A total of 111 patients diagnosed with aneurysm by digital subtraction angiography(DSA)or surgery,underwent cranial CT angiography(CTA)were retrospectively collected from January 2010 to December 2016 at the Department of Diagnostic Radiology,Jinling Clinical College of Xuzhou Medical University(General Hospital of Eastern Theater Command).Among them,41 were males and 70 were females,ranging in age from 32 to 83(56±11)years old.The patients were divided into the ruptured group(n=54)and unruptured group(n=57)based on the hemorrhagic manifestation on non-enhanced CT images or DSA or surgery of the head.Demographics and the morphological characteristics of the aneurysms were evaluated.Hemodynamic parameters,including wall share stress,wall share stress gradient,and others were obtained in overall using computational fluid dynamics simulation technique.Characteristics were compared between the ruptured and unruptured groups.Logistic regression analysis was applied to evaluate the independent risk factors for rupture,and the hemodynamic characteristics associated with dorsal and non-dorsal aneurysms were analyzed,respectively.Results Compared with the unruptured group,patients in the ruptured group were younger((54.2±11.4)years and(58.3±9.9)years,P=0.033),mostly female(74.1%vs 52.6%,P<0.05),with a higher proportion of hypertension(46.3%vs 22.8%,P=0.009).The ruptured internal carotid artery aneurysms(ICAAs)were more frequently located at the dorsal of an arterial arch(57.4%vs 36.8%,P<0.05),and the flow of the blood was more complex,concentrated,unstable,and with a smaller impingement zone(68.5%vs 33.3%,55.6%vs 10.5%,72.2%vs 26.3%and 79.6%vs 36.8%,respectively,all P<0.05).Logistic regression demonstrated that women,hypertension,dorsal,concentrated flow pattern,and unstable flow pattern were an independent risk factors for ICAAs rupture[OR=3.551(1.080-11.679),3.900(1.172-12.976),4.966(1.504-16.401),51.893(7.913-340.296)and 50.015(8.423-296.985),respectively,all P<0.05].The ruptured ICAAs located at non-dorsal had more concentrated,unstable,and with smaller impingement zone(P<0.05),while those at dorsal had more complex,concentrated,and unstable flow patterns,and with smaller impingement zone(all P<0.05).Conclusion Women,hypertension,dorsal concentration,and unstable flow pattern are independent risk factors for the rupture of ICAAs.The dorsal locations of ICAAs could have a higher risk of rupture.