非均勻孔隙率人工支架於側向動脈瘤之流場特性研究

HASH(0x1a88b430)

游臣恩

動脈瘤 ； 非均勻孔隙率人工支架 ； 血液動力學 ； 質點影像測速儀 ； HASH(0x1a88bf40) ； HASH(0x1a88bfe0) ； HASH(0x1a88c080) ； HASH(0x1a8926a0)

清華大學動力機械工程學系學位論文

2008年

碩士

劉通敏

繁體中文

歷年來腦血管疾病常居國人十大死因的第二名，其中又以顱內動脈瘤破裂為致死主因，目前盛行之治療方法為藉由微細導管將線圈與人工支架置放於動脈瘤開口處，藉以阻礙血液流入動脈瘤內，使瘤內形成血栓，造成瘤體萎縮，來達到治療之目的。先前文獻指出血液動力特性(瘤內流場、壁面剪應力及壓力)與動脈瘤成長破裂過程及血栓形成有重要關係，高剪應力及高血壓會導致動脈瘤成長與破裂，低剪應力區及血流停滯區有助於瘤內血栓形成。目前臨床治療為了引導人工支架穿行於彎曲之腦動脈到達病杜所在位置，而受限於採用低孔隙率(Cα)(較高可繞性或可操作性)之單層腦部人工支架，然而為了加速血栓之形成，已有醫生開始嘗試使用多層人工支架(提高Cα)來治療。究竟適當之人工支架為幾層，臨床上尚無定論，尤有進者，目前文獻多著墨於均勻Cα大小之影響，對於非均勻Cα人工支架之效果的探討甚少，此一事實構成本文研究動機。本文採用非干擾性之視流觀測法、質點影像測速技術及壁壓量測，探討加裝Cα為80％的單層商用Wallstent人工支架後，再分別於瘤體開口處近端1/2區域、遠端1/2區域及近端與遠端各1/4區域局部加裝第二層(Cα=80%)支架，探討此三種局部加密非均勻Cα人工支架對於瘤內血液動力特性之影響。實驗之內頸動脈瘤體模型角度為45°、母管曲率為2.5、生理脈動波形之沃門斯里數為4.0及雷諾數為202∼384。實驗結果以瞬時速度場、瘤內平均速度、壁面剪應力及壓力分佈等來探討，發現在波峰相位下，在近端與遠端加密會導致瘤體內壁所受之剪應力值皆低於易促進血栓形成之臨界低剪應力值(0.5Pa)，效果最佳；如就所探討之所有血液動力參數評估，近端與遠端同時加密功效亦最佳、遠端加密次之、近端加密最差。這些發現可供欲採用非均勻性孔隙率人工支架之廠商與醫師參考。

HASH(0x1a8927e0)

1. Aenis, M., Stancampiano, A.P., Wakhloo, A.K. and Lieber, B.B. (1997) Modeling of Flow in a Straight Stented and Nonstented Side Wall Aneurysm Model, ASME J. of Biomechanical Engineering., 19:206-212.
   連結：
2. Alzamora, M.G.., Rosahl, S.K., Lehmberg, J. and Klisch, J. (2005) Life-threatening Bleeding From A Vertebral Artery Pseudoaneurysm After Anterior Cervical Spin Approach: Endovascular Repair by A Triple Stent-in-Stent Method. Case Report, Neuroradiology., 47:282-286.
   連結：
3. Ahn, J.Y., Chung, S.S., Lee, B.H., Kim, S.H., Yoon, P.H., Joo, J.Y. and Kim, J.K. (2005) Treatment of spontaneous arterial dissections with stent placement for preservation of the parent artery, Acta Neurochir., 147:265-273
   連結：
4. Benndorf G., Herbon U., Sollmann W.P. and Campi A., (2001) Treatment of A Ruptured Dissecting Vertebral Artery Aneurysm With Double Stent Placement: Case Report, AJNR. American Journal of Neuroradiology., 2:1844-1848.
   連結：
5. Berry, J.L., Santamarina, A., MOORE, J.E., Roychowdhury, S., and Routh, W. (2000) Experimental and Computational Flow Evaluation of Coronary Stents, Annals of Biomedical Engineering.,28:386-398
   連結：
6. Brownlee, B.D., Tranmer, B.I. , Sevick, R.J., Karmy, G. and Curry, J.C. (1995) Spontaneous thrombosis of an unruptured anterior communicating artery aneurysm, Stroke., 26:1945-1949.
   連結：
7. Burleson, A.C., Strother, C.M. and Turitto, V.T. (1995) Computer modeling of intracranial saccular and lateral aneurysms for the study of their hemodynamics, Neurosurgery., 37(4):774-782; discussion 782-784.
   連結：
8. Crompton, M.R. (1966) Mechanism of growth and rupture in cerebral. berry aneurysms, Br Med J., 1:1138-1142.
   連結：
9. Dotter, C.T. and Judkins, M.P. (1964) Transluminal treatment of arteriosclerotic obstruction. description of a new technic and a preliminary report of its application, Circulation., 30:654–670.
   連結：
10. Ferguson, G.G. (1972) Physucal factors in the initiation, growth, and rupture of human intracranial saccular aneurysms, J. Neurosurg., 37:666-677.
    連結：
11. Harlal, A., Ojha, M. and Johnston, K.W. (2007) Vena Cava Filter Performance Based on Hemodynamics and Reported Thrombosis and Pulmonary Embolism Patterns, J Vasc Interv Radiol., 18:103-115
    連結：
12. Hashimoto, T. (1984) Dynamics measurement of pressure and flow velocities in glass and silastic model berry aneurysms, Neurol. Res., 6:22-28.
    連結：
13. Hoi, Y., Meng, H., Woodward, S.H., Bendok, B.R., Hanel, R.A., Guterman, L.R. and Hopkins, L.N. (2004) Effects of arterial geometry on aneurysm growth: threedimensional computational fluid dynamics study, J. Neurosurg., 101:676-681.
    連結：
14. Hong, S.B. and Kyehan, R. (2003) Intraaneurysmal flow changes affected by clip location and occlusion magnitude in a lateral aneurysm model, Medical Engineering & Physics., 25:581-589.
    連結：
15. Kayembe, K.N., Sasahara M. and Hazama, F. (1984) Cerebral aneurysms and variations in the circle of willis, Stroke., 15(5):846-850.
    連結：
16. Kerber, C.W., Hecht, S.T., Knox, K, Buxton, R.B. and Meltzer, H.S. (1996) Flow dynamics in a fatal aneurysm of the basilar artery, AJNR., 17:1417–21.
    連結：
17. Kumar, B.V.R. and Naidu, K.B. (1994) Hemodynamics in Aneurysm, Computers and Biomedical Research., 29:119–139
    連結：
18. Larson, R.A., Solomon, J. and Carpenter, J.P.,(2002) Stent graft repair of visceral artery aneurysms, Journal of Vascular Surgery., 36:1260-1263
    連結：
19. Liber, B.B., Stancampiano, A.P. and Wakhloo, A.K. (1997) Alteration of Hemodynamics in Aneurysm Models by Stenting: Influence of Stent Porosity, Biomedical Engineering Society., 25:460-469
    連結：
20. Liber, B.B., Livescu, V., Hopkins, L.N. and Wakhloo, A.K. (2002) Particle Image Velocimetry Assessment of Stent Design Influence, Annals of Biomedical Engineering.,30:768-777.
    連結：
21. Liepsch, D.W., Steiger, H.J., Poll A. and Reulen H.J. (1987) Hemodynamic stress in lateral saccular aneurysms, Biorheology., 24(6):689-710.
    連結：
22. Liou, T.M., Chang, W.C. and Liao, C.C.(1997b) LDV measurements in lateral model aneurysms of various sizes, Experiments in Fluids., 23(4):317-324.
    連結：
23. Liou, T.M., Li, Y.C. and Juan, W.C. (2006) Numerical and experimental studies on pulsatile flow in aneurysms arising laterally from a curved parent vessel at various angles, J. Biomechanics., 40(6):1268-1275.
    連結：
24. Liou, T.M. and Liao, C.C. (1997a) Flowfields in lateral aneurysm arising from parent vessels with different curvatures using PTV, Experiments in Fluids., 23:288-298.
    連結：
25. Liou, T.M. and Liou, S.N. (2004a) Pulsatile flows in a lateral aneurysm anchored on a stented and curved parent vessel, Journal of Experimental Mechanics., 44(3):253–260.
    連結：
26. Malek, A.M., Alper, S.L. and Izumo, S. (1999) Hemodynamic shear stress and its role in atherosclerosis, JAMA : The Journal of The American Medical Association., 282:2035-2042.
    連結：
27. Nichols, W. and O’Rourke, M. (1990) McDonald’s flow in arteries, Lea & Febiger, Philadelphia, London.
    連結：
28. Niimi, H., Kawano, Y. and Sugit, I. (1984) Structure of blood flow through a curved vessel with an aneurysm, Biorheology., 21:603-615.
    連結：
29. Ohkubo, T., Fukazawa, R., Ikegami, E. and Ogawa, S. (2007) Reduced shear stress and disturbed flow may lead to coronary aneurysm and thrombus formations, Pediatrics International., 49(1):1-7.
    連結：
30. Rhee, K., Han, M.H. and Cha, S.H. (2002) Changes of flow characteristics by stenting in aneurysm models: influence of aneurysm geometry and stent porosity, Annals of Biomedical Engineering., 30:894-904.
    連結：
31. Rhee, K. and Lee, S.M. (1998) Effects of Radial Wall Motion and Flow Waveform on the Wall Shear Rate Distribution in the Divergent Vascular Graft, Annals of Biomedical Engineering., 26:955-964
    連結：
32. Rudin, S., Wang Z., Kyprianou, L., Hoffmann, K. R., Wu, Y., Meng, H., Guterman, L., Nemes, B., Bednarek, D. R., Dmochowski, J. and Hopkins, L. N. (2004) Measurement of Flow Modification in Phantom Aneurysm Model: Comparison of Coils and a Longitudinally and Axially Asymmetric Stent—Initial Findings, Radiology., 231:272-276
    連結：
33. Sahs, A.L. (1966) Observations on the pathology of saccular aneurysms, J. Neurosurg., 24:792-806.
    連結：
34. Sekhar, L.N. and Heros, R.C. (1981) Origin, growth, and rupture of saccular aneurysms: a review, Neurosurgery., 8(2):248-260.
    連結：
35. Stuhne, G.R. and Steinman, D.A. (2004) Finite-element modeling of the hemodynamics of stented aneurysms, Journal of Biomechanical Engineering., 126:382-387
    連結：
36. Suzuki, J. and Ohara, H. (1978) Clinicopathological study of cerebral aneurysms: origin, rupture, repair, and growth, J Neurosurg., 48(4):505-514.
    連結：
37. Wiebers, D.O., Whisnant, J.P. and Huston, J. (2003) Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment, Lancet. 2003 Jul 12., 362(9378):103-10.
    連結：
38. Yu, S.C.M. and Zhao, J.B. (1999) A steady flow analysis on the stented and non-stented sidewall aneurysm models, Medical Engineering & Physics., 21:133-141
    連結：
39. Zenteno, M., Freitas, J.M.M., Murrieta, Y.A., Koppe, G., Machado, E. and Lee, A., (2006) Balloon-expandable stenting with and without coiling for wide-neck and complex aneurysms, Surgical Neurology., 66:603-610
    連結：
40. 行政院衛生署：中華民國公共衛生概況。行政院衛生署，2007
    連結：
41. Bando, K. and Berger, S.A. (2003) Research on fluid-dynamic design criterion of stent used for treatment of aneurysms by means of computational simulation, Computational Fluid Dynamics Journal., 11:527-531.
42. Foutrakis, G., Yonas, H., Sclabassi, R. (1999) Saccular aneurysm formation in curved and bifurcating arteries, Am J Neuroradiol, 20:1309-1317.
43. Graves, V.B., Strother, C.M., Partington, C.R. and Rappe, A., (1992) Flow dynamics of lateral carotid artery aneurysms and their effects on coils and balloons: an experimental study in dogs, American Journal of Neuroradiology.,13:189-196
44. Imbesi, S.G. and Kerber, C.W. (2001) Analysis of Slipstream Flow in a Wide-necked Basilar Artery Aneurysm: Evaluation of Potential Treatment Regimens, AJNR., 22:721-724
45. Liou, T.M., Ting, T.W. and Chen, Y.M. (2004b) Numerical Simulation on Intracranial Pulsatile Flow in a Curved Parent Vessel with a Lateral Aneurysm, The 11th National Computational Fluid Dynamics Conference, Taitung, Taiwan.
46. Mantha, A., Karmonik, C., Benndorf, G., Strother, C. and Metcalfe, R. (2006) Hemodynamics in a Cerebral Artery before and after the Formation of an Aneurysm, AJNR., 27:1113-1118
47. Massound, T. F., Guglielmi, G., Vieula, C., Ji, F. and Duckwiler, G. R. (1994) Experimental saccular aneurysms I. Review of surgically constructed models and their laboratory applications, Neuroradilolgy., 36:537-546.
48. Roth, T.C., Chaloupka, J.C., Putman, .C.M., Ross, D.A., Weaver, E.M., Tarro, J., Wecht, D.M. and Sasaki, C.T. (1998) Percutaneous Direct-Puncture Acrylic Embolization of a Pseudoaneurysm after Failed Carotid Stenting for the Treatment of Acute Carotid Blowout, Am J . Neuroradiol., 19:912-916
49. Strother, C.M., Graves, V.B. and Rappe, A. (1992) Aneurysm hemodynamics: an experimental study, AJNR., 13(4):1089-1095.
50. Wang, T. C., (2007) 內頸動脈瘤瘤內速度與壓力分佈量測-不同人工支架幾何之效應，國立清華大學，碩士論文。