目的分析中国主动脉弓部病变人群的解剖特征,为国产化腔内器械的研发提供解剖学依据。方法收集2021年6月1日至2024年1月1日全国17个中心开展的WeFlow-Arch支架系统首个前瞻性多中心研究中的83例主动脉弓部病变患者的数据。根据病变类型...目的分析中国主动脉弓部病变人群的解剖特征,为国产化腔内器械的研发提供解剖学依据。方法收集2021年6月1日至2024年1月1日全国17个中心开展的WeFlow-Arch支架系统首个前瞻性多中心研究中的83例主动脉弓部病变患者的数据。根据病变类型分为动脉瘤组67例和溃疡组16例。将术前CT血管造影数据导入专业图像处理软件进行三维重建,基于血管中心线测量并比较主动脉的相关解剖参数,评估Zenith支架和Relay支架在中国患者中的解剖适应性。结果Zenith支架和Relay支架在中国患者中的解剖适应性分别为39.8%和63.9%。动脉瘤组与溃疡组在主动脉弓分型、主动脉直径及距离、弓上分支血管直径及长度、时钟位置及角度、左右股动脉直径、近端主动脉及主动脉整体弯曲指数等解剖指标比较,差异无统计学意义(P>0.05)。动脉瘤组升主动脉弯曲指数明显低于溃疡组(1.17±0.06 vs 1.22±0.08,P=0.010),支架假体近似覆盖区域弯曲指数明显高于溃疡组(2.97±0.46 vs 2.66±0.36,P=0.020)。结论不同主动脉弓部病变在升主动脉和支架覆盖区域的弯曲程度上存在显著差异,需关注其对预后的潜在影响。国外相关器械在中国患者中的解剖适应性较差,研发适合中国患者的国产腔内器械具有重要意义。展开更多
Embedded modular branched stent graft(EMBSG)was a new option for aortic arch aneurysm.However,the therapeutic effect of this innovative stenting technique has not been fully assessed.Computational fluid dynamics and t...Embedded modular branched stent graft(EMBSG)was a new option for aortic arch aneurysm.However,the therapeutic effect of this innovative stenting technique has not been fully assessed.Computational fluid dynamics and three-dimensional structural analyses were performed on three patients(Patient Ⅰ,Patient Ⅱ and Patient Ⅲ)with aortic arch aneurysm,both before and after EMBSG implantation.Patient-specific alterations from preoperative to postoperative were analyzed via morphological and functional metrics.Patient Ⅰ and Patient Ⅱ showed notable curvature changes and area reduction after intervention procedure.Three patients showed an increase in flow velocity after EMBSG implantation,while the pressure drop from ascending aorta to the aortic arch was remarkable in Patient I and Patient Ⅱ with the value of 7.09mmHg,and 10.95mmHg,respectively.Patient I and Patient Ⅱ also showed elevated time-averaged wall shear stress(TAWSS)in the stenting region,while Patient Ⅲ showed a trivial change in TAWSS after intervention procedure.Three patients showed low relative residence time after EMBSG insertion.The short-term results of EMBSG in treating aortic arch aneurysm were promising.Hemodynamic parameters have the potential to assist in the outcome evaluation and might be used to guide the stent graft design and wise selection,thereby improving the long-term therapeutic effect in managing complex vascular disease.展开更多
文摘目的分析中国主动脉弓部病变人群的解剖特征,为国产化腔内器械的研发提供解剖学依据。方法收集2021年6月1日至2024年1月1日全国17个中心开展的WeFlow-Arch支架系统首个前瞻性多中心研究中的83例主动脉弓部病变患者的数据。根据病变类型分为动脉瘤组67例和溃疡组16例。将术前CT血管造影数据导入专业图像处理软件进行三维重建,基于血管中心线测量并比较主动脉的相关解剖参数,评估Zenith支架和Relay支架在中国患者中的解剖适应性。结果Zenith支架和Relay支架在中国患者中的解剖适应性分别为39.8%和63.9%。动脉瘤组与溃疡组在主动脉弓分型、主动脉直径及距离、弓上分支血管直径及长度、时钟位置及角度、左右股动脉直径、近端主动脉及主动脉整体弯曲指数等解剖指标比较,差异无统计学意义(P>0.05)。动脉瘤组升主动脉弯曲指数明显低于溃疡组(1.17±0.06 vs 1.22±0.08,P=0.010),支架假体近似覆盖区域弯曲指数明显高于溃疡组(2.97±0.46 vs 2.66±0.36,P=0.020)。结论不同主动脉弓部病变在升主动脉和支架覆盖区域的弯曲程度上存在显著差异,需关注其对预后的潜在影响。国外相关器械在中国患者中的解剖适应性较差,研发适合中国患者的国产腔内器械具有重要意义。
基金Beijing Natural Science Foundation(Z210012,7212094)National Natural Science Foundation of China(81970404,82170498)Beijing Science and Technology Planning Project(Z211100002921048).
文摘Embedded modular branched stent graft(EMBSG)was a new option for aortic arch aneurysm.However,the therapeutic effect of this innovative stenting technique has not been fully assessed.Computational fluid dynamics and three-dimensional structural analyses were performed on three patients(Patient Ⅰ,Patient Ⅱ and Patient Ⅲ)with aortic arch aneurysm,both before and after EMBSG implantation.Patient-specific alterations from preoperative to postoperative were analyzed via morphological and functional metrics.Patient Ⅰ and Patient Ⅱ showed notable curvature changes and area reduction after intervention procedure.Three patients showed an increase in flow velocity after EMBSG implantation,while the pressure drop from ascending aorta to the aortic arch was remarkable in Patient I and Patient Ⅱ with the value of 7.09mmHg,and 10.95mmHg,respectively.Patient I and Patient Ⅱ also showed elevated time-averaged wall shear stress(TAWSS)in the stenting region,while Patient Ⅲ showed a trivial change in TAWSS after intervention procedure.Three patients showed low relative residence time after EMBSG insertion.The short-term results of EMBSG in treating aortic arch aneurysm were promising.Hemodynamic parameters have the potential to assist in the outcome evaluation and might be used to guide the stent graft design and wise selection,thereby improving the long-term therapeutic effect in managing complex vascular disease.
