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人体两侧椎动脉形态差异及其对血流动力学的影响
Morphological differences of bilateral vertebral arteries and their effects on hemodynamics
【摘要】 目的 分析左右侧椎动脉的几何形态及血流动力学差异,揭示椎动脉狭窄偏侧化现象背后的解剖学和血流动力学机理,为椎动脉狭窄的风险评估及支架治疗优化提供参考。方法 获取15例健康人的头颈部CT血管造影(CT angiography, CTA)图像,构建左右侧椎动脉起始部的三维模型,并测量管径、弯曲度等血管形态特征参数,统计分析了两侧椎动脉的形态差异及影响因素。通过主成分分析筛选出两侧椎动脉的典型模型,并进行血流动力学数值模拟,比较两侧血流流速、壁面剪切应力(Time-Averaged Wall Shear Stress, TAWSS)、振荡剪切因子(Oscillatory Shear Index, OSI)等因素的分布差异。结果 左右侧椎动脉模型形态存在显著性差异,左侧锁骨下动脉的管径及曲率半径更小,左侧椎动脉管径及迂曲度更大,右侧椎动脉起始部分叉处的非平面性更大。典型椎动脉模型的血流动力学对比研究表明,右侧椎动脉内血流流速、流量更小,右侧椎动脉起始部的TAWSS更低,OSI更大,提示右侧椎动脉更易发生狭窄等动脉粥样硬化疾病。结论 本研究阐明了健康人左右侧椎动脉的形态差异,研究了典型椎动脉模型中血流动力学参数的分布差异,可为阐明椎动脉狭窄偏侧化机制提供参考。在进行椎动脉狭窄的介入治疗时,应考虑椎动脉解剖上及血流动力学上的生理不对称性,采取具有针对性的介入治疗方案。
【Abstract】 Objective This study aims to analyze the geometrical and hemodynamic differences of the left and right vertebral arteries, so as to reveal the anatomy and hemodynamic mechanism behind the vertebral artery stenosis lateralization phenomenon, and provide references for the risk assessment of vertebral artery stenosis and stent treatment. Methods The head and neck CT angiography(CTA) images of 15 healthy subjects were obtained, and the 3D models for the origin segment of the left and right vertebral arteries were constructed. The vascular morphological features such as diameter and curvature were measured, and the geometric differences and influencing factors of the two sides of vertebral arteries were statistically analyzed. The typical model of bilateral vertebral arteries was identified by principal component analysis, and the hemodynamic numerical simulation was carried out to compare the hemodynamics characteristics between the bilateral vertebral arteries, such as the blood flow velocity, time-averaged wall shear stress(TAWSS), and oscillatory shear index(oscillatory shear index) OSI) and others. Results There were significant differences in the morphology of the left and right vertebral arteries, the diameter and curvature radius of the left subclavian artery was smaller, the diameter and tortuosity of the left vertebral artery was larger, and the non-planarity of the bifurcation at the beginning of the right vertebral artery was larger. The hemodynamic comparative study of the typical vertebral artery model showed that the blood flow velocity and flow rate in the right vertebral artery were smaller, the TAWSS was lower, and the OSI was larger, suggesting that the right vertebral artery was more prone to stenosis and other atherosclerotic diseases. Conclusion This study elucidated the morphological differences of left and right vertebral arteries in healthy people, and studied the distribution differences of hemodynamic parameters in the typical vertebral artery models, which can provide references for revealing the causes of lateralization of vertebral artery stenosis. In the interventional treatment of vertebral artery stenosis, the anatomical and hemodynamic physiological asymmetry of vertebral artery should be considered and targeted interventional treatment should be adopted.
【Key words】 Vertebral artery stenosis; Lateralization; Geometry; Hemodynamics;
- 【文献出处】 现代仪器与医疗 ,Modern Instruments & Medical Treatment , 编辑部邮箱 ,2022年05期
- 【分类号】R322.121
- 【下载频次】6