动脉瘤相关问题建模分析、评估

题目：Hemodynamic differences between unstable and

stable unruptured aneurysms independent of size

and location: a pilot study

与大小和位置无关的不稳定和稳定未破裂动脉瘤之间的血流动力学差异：一项初步研究

ABSTRACT

Background

While clinical and angiographic risk factors for intracranial aneurysm instability are well established, it is reasonable to postulate that intraaneurysmal hemodynamics also have a role in aneurysm instability.

虽然对颅内血管瘤的不稳定性的临床和造影剂风险已经被很好地证实，但有理由假设动脉瘤内血流动力学也在动脉瘤不稳定性中起作用。

Objective

To identify hemodynamic characteristics that  differ between radiologically unstable and stable  unruptured intracranial aneurysms.

确定放射学不稳定和稳定未破裂颅内动脉瘤之间不同的血流动力学特征。

Conclusions

This pilot study suggests there may be hemodynamic differences between unstable and stable unruptured cerebral aneurysms. In particular, the area under low wall shear stress was larger in unstable aneurysms. These findings should be considered tentative until confirmed by future larger studies.

这项初步研究表明，不稳定和稳定的未破裂脑动脉瘤之间可能存在血流动力学差异。 特别是，在不稳定的动脉瘤中，低壁剪切应力下的面积更大。 在未来更大规模的研究证实之前，这些发现应该被认为是暂时的。

题目

Hemodynamic vascular biomarkers for initiation of paraclinoid internal carotid artery aneurysms using patient-specific computational fluid dynamic simulation based on magnetic resonance imaging

使用基于磁共振成像的患者特异性计算流体动力学模拟的，用于起始旁床突颈内动脉瘤的血流动力学血管生物标志物

Abstract

Purpose

We performed computational fluid dynamics (CFD) for patients with and without paraclinoid internal carotid artery (ICA) aneurysms to evaluate the distribution of vascular biomarkers at the aneurysm initiation sites of the paraclinoid ICA.

我们对有和没有床旁颈内动脉 (ICA) 动脉瘤的患者进行了计算流体动力学 (CFD)，以评估血管生物标志物在床旁 ICA 动脉瘤起始部位的分布。

Conclusion

Our findings indicated that nh-WSS and nh-SWSSG were good biomarkers for aneurysm initiation in the paraclinoid ICA.

我们的研究结果表明，nh-WSS (normalized highest wall shear stress) 和 nh-SWSSG (nh-spatial WSS gradient) 是床旁 ICA 动脉瘤起始的良好生物标志物。

题目

Factors affecting formation and rupture of intracranial saccular aneurysms

影响颅内囊状动脉瘤形成和破裂的因素

Abstract

Unruptured intracranial aneurysms represent a decisional challenge. Treatment risks have to be balanced against an unknown probability of rupture. A better understanding of the physiopathology is the basis for a better prediction of the natural history of an individual patient. Knowledge about the possible determining factors arises from a careful comparison between ruptured versus unruptured aneurysms and from the prospective observation and analysis of unbiased series with untreated, unruptured aneurysms. The key point is the correct identification of the determining variables for the fate of a specific aneurysm in a given individual. Thus, the increased knowledge of mechanisms of formation and eventual rupture of aneurysms should provide significant clues to the identification of rupture-prone aneurysms. Factors like structural vessel wall defects, local hemodynamic stress determined also by peculiar geometric configurations, and inflammation as trigger of a wall remodeling are crucial. In this sense the study of genetic modifiers of inflammatory responses together with the computational study of the vessel tree might contribute to identify aneurysms prone to rupture. The aim of this article is to underline the value of a unifying hypothesis that merges the role of geometry, with that of hemodynamics and of genetics as concerns vessel wall structure and inflammatory pathways.

未破裂的颅内动脉瘤是一项决策挑战。治疗风险必须与未知的破裂概率相平衡。更好地了解病理生理学是更好地预测个体患者自然病程的基础。关于可能的决定因素的知识来自破裂动脉瘤与未破裂动脉瘤之间的仔细比较，以及对未经治疗的未破裂动脉瘤的无偏见系列的前瞻性观察和分析。关键点是正确识别特定个体中特定动脉瘤命运的决定变量。因此，对动脉瘤形成和最终破裂机制的更多了解应该为识别易破裂的动脉瘤提供重要线索。诸如结构性血管壁缺陷、也由特殊几何结构决定的局部血流动力学应力以及作为壁重塑触发因素的炎症等因素都是至关重要的。从这个意义上说，炎症反应的遗传修饰物的研究以及血管树的计算研究可能有助于识别容易破裂的动脉瘤。本文的目的是强调统一假设的价值，该假设将几何学、血流动力学和遗传学的作用与血管壁结构和炎症通路相结合。

Conclusions

All these analyses show that from a purely morphological point of view, a multi-parametric case-specific study seems warranted. Like the understanding of most complex biological phenomena, it is unlikely that the understanding of IAs dynamics will be captured entirely by mathematical models. However, the use of the latter has the potential to provide a great support in the identification of contributing and meaningful factors and eventually in their ranking, which could prospectively provide a support tool for decision making.

所有这些分析表明，从纯粹的形态学角度来看，多参数案例特定研究似乎是有必要的。 就像对大多数复杂生物现象的理解一样，对 IA 动力学的理解不太可能完全被数学模型所捕获。 然而，后者的使用有可能为识别贡献和有意义的因素并最终在它们的排名中提供很大的支持，这可以前瞻性地为决策提供支持工具。

Their reliability benefits from the increase of accuracy in simulation and from retrospective and, where treatment is delayed, from observational validation. Furthermore, genetic heterogeneity of inflammatory and tissue-specific remodeling features might in great part explain possible false positives and negatives identified by mathematical geometric and HD models.

它们的可靠性得益于模拟准确性的提高和回顾性的提高，以及在治疗延迟的情况下，观察性验证。 此外，炎症和组织特异性重塑特征的遗传异质性可能在很大程度上解释了数学几何和 HD 模型识别出的可能的假阳性和阴性。

The issue of whether to treat or not an UA and which treatment technique to chose requires multiple considerations:

是否要治疗UA以及用什么技术治疗需要几方面的考虑：

First, better knowledge on natural history of IAs is required and this necessitates further efforts to accurately collect epidemiological data.

首先，需要更好地了解 IA 的自然史，这需要进一步努力准确收集流行病学数据。

Also an increased analytical knowledge about treatment-associated risks is necessary. An interesting probabilistic and interactive decision analysis system is proposed in [47], where age, life expectation, surgical, endovascular, and RRs together with the expected annual rupture rate are taken into consideration.

此外，还需要增加有关治疗相关风险的分析知识。[47] 中提出了一个有趣的概率和交互式决策分析系统，其中考虑了年龄、预期寿命、手术、血管内和 RR 以及预期的年破裂率。

However, the ambition of obtaining all information needed to univocally have a picture of natural history seems not to be realistic: one reason is that refusing treatment in a patient series for observational study purposes seems not to be justified and another reason is that each aneurysm might be comparable with others but has always its own peculiarities.

然而，获得明确自然病史图片所需的所有信息的雄心似乎并不现实：一个原因是为了观察性研究目的而拒绝对患者系列进行治疗似乎没有道理，另一个原因是每个动脉瘤可能 可与他人相提并论，但总有自己的特点。

Different situations evidenced by reliable simulations and RR analyses may exist: cases where RRs exceed the best treatment-associated risks and cases where RR is far lower than treatment-associated risks.

可能存在由可靠模拟和 RR （risk of repture） 分析证明的不同情况：RR 超过最佳治疗相关风险的情况和 RR 远低于治疗相关风险的情况。

Furthermore, the possibility of performing HD simulations in the real geometry of patients, including the consideration of contact constraints of vessel and aneurysm through better imaging devices, would allow to better plan a proper treatment strategy for each patient, addressing not only the sac itself, but also the identified HD defect on the parent vessel, e.g., with flow-diverting stents.

此外，在患者的真实几何结构中进行 HD (hemodynamic) 模拟的可能性，包括通过更好的成像设备考虑血管和动脉瘤的接触限制，将允许为每个患者更好地规划适当的治疗策略，不仅解决囊本身， 以及已识别的母血管上的 HD 缺陷，例如，带有分流支架。

If in future technical progress including the extended use of intraoperative monitoring, together with the development of improved tools for aneurysm occlusion, was to lead to lower therapeutic risks and secure results, i.e., a proper “cure”, without delayed complications, evaluation of RR will lose its importance. At this point les