Lanlan Li, Yiwei Wang, Ping Jin, Tingting Yang, Guangyu Zhu, Yuxi Li, Jiayou Tang, Yang Liu, Jian Yang
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引用次数: 0
Abstract
Objectives: To evaluate the changes in distal vascular morphology and hemodynamics in patients with extremely severe aortic coarctation (CoA) after covered palliative (CP) stent dilation with different surgical strategies.
Materials and methods: Perioperative computed tomography angiography and digital subtraction angiography were utilized to construct three aortic models with varying stenosis rates and one follow-up model in a patient with extremely severe CoA. The models included: an idealized non-stenosed model (A: 0%), a model post initial stent deployment (B: 28%), a model post balloon expansion (C: 39%), and a model 18 months after post-balloon expansion (D: 39%). Consistent boundary conditions were applied to all models, and hemodynamic simulation was conducted using the pure fluid method.
Results: The narrowest and distal diameter of the stent increased by 34.71% and 59.29%, respectively, from model B to C. Additionally, the distal diameter of the stent increased by -13.80% and +43.68% compared to the descending aorta diameter, respectively. Furthermore, the ellipticity of the maximum cross-section of the aneurysm region in model A to D continued to increase. The oscillatory shear index at the stenosis to the region of the aneurysm were found to be higher in Models A and B, and lower in Models C and D. At the moment of maximum flow velocity, the blood flow distribution in models A and B was more uniform in the widest section of the blood vessels at the distal end of the stenosis, whereas models C and D exhibited disturbed blood flow with more than 2 eddy currents. The time-averaged wall shear stress (TAWSS) decreased in the distal and basal aneurysms, while it significantly increased at the step position. The aneurysmal region exhibited an endothelial cell activation potential value lower than 0.4 Pa-1.
Conclusion: In patients with extremely severe CoA, it is crucial to ensure that the expanded diameter at both ends of the CP stent does not exceed the native vascular diameter during deployment. Our simulation results demonstrate that overdilation leads to a decrease in the TAWSS above the injured vessel, creating an abnormal hemodynamic environment that may contribute to the development and enlargement of false aneurysms in the early postoperative period.
目的评估极重度主动脉缩窄(CoA)患者在采用不同手术策略进行有盖姑息性支架扩张术后远端血管形态和血流动力学的变化:利用围手术期计算机断层扫描血管造影术和数字减影血管造影术构建了三个不同狭窄率的主动脉模型和一个极重度 CoA 患者的随访模型。这些模型包括:理想化的非狭窄模型(A:0%)、初始支架部署后的模型(B:28%)、球囊扩张后的模型(C:39%)以及球囊扩张后 18 个月后的模型(D:39%)。所有模型都采用了一致的边界条件,并使用纯流体法进行了血液动力学模拟:此外,与降主动脉直径相比,支架远端直径分别增加了-13.80%和+43.68%。此外,模型 A 至 D 中动脉瘤区域最大横截面的椭圆度继续增加。在最大流速时刻,模型 A 和 B 在狭窄远端血管最宽处的血流分布较为均匀,而模型 C 和 D 则表现出超过 2 个涡流的紊乱血流。动脉瘤远端和基底的时间平均壁剪应力(TAWSS)有所下降,而在阶梯位置则显著上升。动脉瘤区域的内皮细胞活化电位值低于 0.4 Pa-1:结论:对于患有极度严重 CoA 的患者,确保 CP 支架两端的扩张直径在部署过程中不超过原生血管直径至关重要。我们的模拟结果表明,过度扩张会导致损伤血管上方的 TAWSS 下降,造成异常的血流动力学环境,从而可能导致术后早期假性动脉瘤的发展和扩大:临床试验注册:ClinicalTrials.gov,(NCT02917980)。
期刊介绍:
Frontiers? Which frontiers? Where exactly are the frontiers of cardiovascular medicine? And who should be defining these frontiers?
At Frontiers in Cardiovascular Medicine we believe it is worth being curious to foresee and explore beyond the current frontiers. In other words, we would like, through the articles published by our community journal Frontiers in Cardiovascular Medicine, to anticipate the future of cardiovascular medicine, and thus better prevent cardiovascular disorders and improve therapeutic options and outcomes of our patients.