文献类型：期刊文献

中文题名：单层或双层裸金属支架治疗冠状动脉瘤的流体力学分析

英文题名：Fluid Mechanics Analysis of Single or Double-layer Bare Metal Stents for the Intervention of Coronary Artery Aneurysms

作者：杨卓璇[1];袁建松[2];崔锦钢[2];付文宇[3];乔爱科[1];周越[1];马越[2,5];屈艳玲[1];乔树宾[2,4]

第一作者：杨卓璇

机构：[1]山西省运城市中心医院、心血管内科,044000;[2]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院冠心病中心;[3]北京联合大学机器人学院;[4]北京工业大学环境与生命学部生物医学工程系;[5]南昌大学第二附属医院心血管内科

第一机构：山西省运城市中心医院、心血管内科,044000

年份：2023

卷号：38

期号：3

起止页码：318-325

中文期刊名：中国循环杂志

外文期刊名：Chinese Circulation Journal

收录：CSTPCD;;北大核心:【北大核心2020】；CSCD:【CSCD2023_2024】；

基金：山西省卫生健康委2022年度卫生健康课题(2022023);中国医学科学院中央级公益性科研院所基本科研业务费临床与转化医学研究基金项目(2019XK320064)。

语种：中文

中文关键词：冠状动脉瘤;裸金属支架;计算流体力学;经皮冠状动脉介入治疗

外文关键词：coronary artery aneurysm;bare metal stent;fluid mechanics analysis;percutaneous coronary intervention

摘要：目的:使用计算流体力学研究单层或双层裸金属支架治疗冠状动脉瘤(冠脉瘤)的新方法。方法:选取5例瘤体直径不同的冠脉瘤患者,分别置入单层或双层裸金属支架治疗,使用计算流体力学方法构建冠脉瘤模型并模拟单、双层裸金属支架置入过程,分析裸金属支架置入后冠脉瘤内血液动力学参数的变化。结果:在模型1(病例1,瘤体直径4 mm)中,相比无支架状态和双层裸金属支架状态,单层裸金属支架状态时血流速度最低。在模型2至模型5(病例2~病例5)中(瘤体直径6.5~16.0 mm),相比无支架状态和单层裸金属支架状态,双层裸金属支架状态的血流速度最低。在模型1和模型2中,随着裸金属支架依次模拟置入,冠脉瘤壁面压力和切应力呈现出下降趋势。模型3、4和5则表现出随着裸金属支架的依次模拟置入,冠脉瘤壁面压力逐渐上升,切应力则呈现出个体化变化。随访发现5例冠脉瘤均成功封闭且无明显支架内再狭窄。结论:瘤体直径<6.5 mm的冠脉瘤可采用单层裸金属支架覆盖瘤颈,瘤体直径在6.5~16.0 mm之间的冠脉瘤建议采用双层裸金属支架覆盖瘤颈。该技术可有效改变冠脉瘤内血流速度及载瘤动脉血流导向,促进瘤体愈合。
Objectives:To investigate the fluid mechanics in patients with coronary artery aneurysms(CAAs)treated by single-layer or double-layer bare metal stents.Methods:Five CAA cases with different aneurysms diameters who underwent single or double-layer bare metal stents were recruited.The CAAs and parent artery diameters were measured for model construction.Single-and double-layer stent implantation was simulated,and the hemodynamics changes in the CAAs after stenting were analyzed.Results:In model 1(CAA diameter:4 mm),the blood flow velocity was the lowest in the single-layer stent condition compared with the stent-free condition and the double-layer stent condition.In model 2 to 5(CAA diameter 6.5 mm to 16.0 mm),the flow velocity was the lowest in the double-layer stent condition compared with the stent-free condition and the single-layer stent condition.In model 1 and 2,the pressure and wall shear stress on the CAAs wall showed a decreasing trend with the sequential implantation of the stent.In model 3,4,and 5,the pressure on the CAAs wall gradually increased,while the wall shear stress presented individual changes with the sequential implantation of the stent.During follow-up,all the CAAs were successfully closed without significant stent restenosis.Conclusions:Single-layer bare metal stents can be used to cover the neck of CAA with<6.5 mm diameter,and doublelayer bare metal stents can be used to cover the neck of CAA with 6.5-16.0 mm diameter.This technology can effectively change the flow in vessels and aneurysm hemodynamics to achieve successful CAA occlusion.