【摘要】：臨床上對窄頸動(dòng)脈瘤已經(jīng)有了比較成熟的實(shí)踐經(jīng)驗(yàn),但是對于相對比較復(fù)雜的寬頸動(dòng)脈瘤臨床經(jīng)驗(yàn)比較少。單純植入支架治療有時(shí)候達(dá)不到理想的臨床效果,這時(shí)就需要支架輔助栓塞技術(shù)進(jìn)行治療。為了研究不同寬頸動(dòng)脈瘤的治療方法,驗(yàn)證單純支架植入和支架輔助栓塞技術(shù)各自在治療這些復(fù)雜顱內(nèi)動(dòng)脈瘤的效果。文章選取了側(cè)壁和分叉兩種寬頸動(dòng)脈瘤進(jìn)行研究。探究這兩種動(dòng)脈瘤在介入治療前后血流動(dòng)力學(xué)各項(xiàng)參數(shù)變化并探究出現(xiàn)這種差異的影響因素。利用逆向工程技術(shù)提取出側(cè)壁動(dòng)脈瘤和分叉動(dòng)脈瘤的三維實(shí)體模型。對兩例寬頸動(dòng)脈瘤輸入相同的入口血流速度(0.2m/s),通過有限元分析軟件模擬分析其各自的血流動(dòng)力學(xué)參數(shù);對側(cè)壁動(dòng)脈瘤植入支架并設(shè)置相同的入口速度進(jìn)行數(shù)值模擬分析,得出血流動(dòng)力學(xué)參數(shù),發(fā)現(xiàn)效果并不十分理想;然后在植入支架的基礎(chǔ)上對動(dòng)脈瘤內(nèi)部進(jìn)行栓塞,再次設(shè)置相同邊界條件進(jìn)行數(shù)值模擬分析并得出血流動(dòng)力學(xué)參數(shù)。支架植入側(cè)壁動(dòng)脈瘤后其最大壁面剪切力由原來的50.17Pa變?yōu)?2.72Pa,血流速度由最初的0.98m/s減小到0.59m/s,在一定程度上有所降低但是效果不太理想,支架輔助栓塞之后最大壁面剪切力變?yōu)?0.45Pa,速度下降至0.32m/s,效果顯著,說明支架輔助栓塞治療側(cè)壁動(dòng)脈瘤有較好的效果。最后對分叉動(dòng)脈瘤植入Y型支架進(jìn)行數(shù)值模擬分析,和上述設(shè)置同樣的邊界條件進(jìn)行模擬,得出植入支架后的各項(xiàng)血流動(dòng)力學(xué)參數(shù)。分叉動(dòng)脈瘤在Y型支架植入后最大壁面剪切力由原來的197.8Pa下降至67.9Pa,最大速度也由原來的0.58m/s下降至0.21m/s,下降程度明顯說明單純植入Y型支架對于治療該類分叉動(dòng)脈瘤就有較好的療效。
[Abstract]:Clinical experience of narrow carotid aneurysm has been more mature, but for relatively complex wide carotid aneurysm clinical experience is relatively small. Stent implantation alone sometimes fails to achieve satisfactory clinical results. Stent-assisted embolization is required. In order to study the treatment methods of different wide carotid aneurysms, the effects of stenting alone and stent-assisted embolization in the treatment of these complex intracranial aneurysms were verified. Two types of wide carotid aneurysms, lateral wall and bifurcation, were selected for study. To explore the changes of hemodynamic parameters before and after interventional therapy and to explore the factors that influence the difference between the two types of aneurysms. Three-dimensional solid models of lateral aneurysms and bifurcation aneurysms were extracted by reverse engineering. Two patients with wide carotid aneurysms were given the same inlet blood flow velocity (0.2m/s) and their hemodynamic parameters were simulated by finite element analysis software. Through numerical simulation and analysis of stenting and setting the same inlet velocity of lateral aneurysm, the hemodynamic parameters were obtained, and the results were not very satisfactory. Then the internal aneurysm was embolized on the basis of stent implantation, and the same boundary conditions were set again for numerical simulation and the hemodynamic parameters were obtained. The maximum wall shear force of stent implanted into lateral aneurysm changed from the original 50.17Pa to 32.72 Pa. the velocity of blood flow decreased from the initial 0.98m/s to 0.59 m / s, to some extent, but the effect was not very good. After stent-assisted embolization, the maximum wall shear force changed to 10.45 Paand the velocity decreased to 0.32 m / s, which indicated that stent-assisted embolization had a better effect on lateral aneurysms. Finally, the numerical simulation of Y-stent implantation in bifurcation aneurysms was carried out, and the same boundary conditions as above were used to simulate the hemodynamic parameters of the implanted stents. The maximum wall shear force decreased from the original 197.8Pa to 67.9 Pa, and the maximum velocity also decreased from the original 0.58m/s to 0.21 m / s after Y stent implantation. The degree of decline obviously indicates that Y-stent implantation alone is effective in the treatment of this type of bifurcation aneurysm.
【學(xué)位授予單位】：新疆大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R654.3;TP391.7

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