Mechanical embolectomy using Penumbra system for acute cerebral embolism: model establishment and finite element analysis in one case

doi:10.3969/j.issn.2095-4344.2014.27.014

Abstract

Abstract:

BACKGROUND: Few cases of acute cerebral embolism were treated by mechanical thrombectomy all over the world. However, there were few cases currently treated by mechanical thrombectomy using Penumbra system. It is an unclear understanding of effects on regional cerebral blood vessels using this kind of surgery.
OBJECTIVE: To describe effects of numerical simulation on regional cerebral blood vessels of an acute cerebral embolism patient by mechanical embolectomy using Penumbra system.
METHODS: A 77-year-old woman suffering from acute cerebral embolism of left middle cerebral artery was selected. Various raw data were collected in emergency of digital subtraction angiography, then mechanical thrombectomy using Penumbra system was carried out successfully. After these raw data were processed into dimensional numerical models of two kinds of embolectomy methods (“suction bolt method from near to far” and “suction bolt method from far to near”), and then finite element analysis was carried out.
RESULTS AND CONCLUSION: Model establishment and finite element analysis were successfully conducted. Compared with “suction bolt method from near to far”, “suction bolt method from far to near” models had smaller velocity of flow in catheter and smaller wall shear stress of thrombus (P < 0.01), and had larger wall shear stress of blood vessel wall, deformation of blood vessel wall (P < 0.01) and deformation of thrombus (P < 0.05). Results suggested that finite element analysis of mechanical embolectomy using Penumbra system can help physicians to involve in a clear understanding of their impacts on cerebral blood vessels of patients. As a research method, it is worth to continue to explore in the future.

中国组织工程研究杂志出版内容重点：肾移植；肝移植；移植；心脏移植；组织移植；皮肤移植；皮瓣移植；血管移植；器官移植；组织工程

全文链接：

Key words: intracranial embolism, blood vessels, finite element analysis, mechanics

CLC Number:

R318

Liu Bo, Xie Peng, Li Zhi-wei. Mechanical embolectomy using Penumbra system for acute cerebral embolism: model establishment and finite element analysis in one case[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(27): 4345-4354.

Figures/Tables 5

2.2 Penumbra机械取栓的18个流固耦合模型的计算结果总体情况由于颈内动脉的灌注压和血流速度随着心跳周期性变化着，故每个流固耦合模型入出口边界条件也周期性变化着。在心动周期每个时刻血液流线图、血液压力降图、血管壁和血栓壁面切应力图、血管壁和血栓变形情况分布图的ANSYS染色均无明显变化，只是色彩代表的值随时在变(图3-5)。因此，在每个模型任选一时刻的ANSYS染色图均能代表该模型各时刻对应分布图的整体情况。 2.3 Penumbra机械取栓的18个流固耦合模型的血液流动情况患者心率为75次/min，故每个心动周期为0.8 s，设患者左侧颈内动脉C5段灌注压某最低值(8 kPa)处为0 s，下一个最低值处时间应为0.8 s。观察两种吸栓方法的每个模型在0-0.8 s的整个心动周期各时刻血液流线图发现：①在“由近及远吸栓法”的4 mm模型中在吸栓导管抽吸前，闭塞大脑中动脉近端无血液流动，血流仅流向大脑中动脉分支，当吸栓导管使用-70 kPa抽吸时，大量血液通过血管残端流入吸栓导管，在2 mm，1 mm，0.5 mm，0.25 mm模型中有与之相同的表现；在“由近及远吸栓法”的0 mm模型中吸栓导管已直接接触血栓，血管残端和吸栓导管内无血液流动(图3A)。②在“由远及近吸栓法”的0 mm，-0.5 mm，-1 mm，-1.5 mm，-2 mm，-2.5 mm，-3 mm模型中血管残端无血液流动，吸栓导管有少许血流，血流来自闭塞远端血管，在0.25 mm模型中有少许血液通过血管残端流向远端血管，另大量血液通过残端流入吸栓导管；在“由远及近吸栓法”的4 mm，2 mm，1 mm，0.5 mm模型中既有大量血液流入吸栓导管，又有较多血液流向远端血管(图3B)。测量两种吸栓方法的每个模型吸栓导管内血流速度发现：①如图3C所示，在“由近及远吸栓法”的4 mm，2 mm，1 mm，0.5 mm，0.25 mm模型中吸栓导管内血流速度随心跳周期性变化着，在0 s，0.8 s处位于最低值，在0.2 s时均达最大值，其值依次为563 cm/s，545 cm/s，522 cm/s，482 cm/s，387 cm/s；但0 mm模型导管内血流速度不随时间变化，始终为0 cm/s。②如图3D所示，在“由远及近吸栓法”的0 mm，-0.5 mm，-1 mm，-1.5 mm，-2 mm，-2.5 mm，-3 mm模型导管内血流速度不随时间变化，始终为4-6 cm/s；在4 mm，2 mm，1 mm，0.5 mm，0.25 mm 模型中吸栓导管内血流速度也随心跳周期性变化着，在0 s，0.8 s处均位于最低值，在0.2 s时均达最大值，其值依次为511 cm/s，496 cm/s，468 cm/s，434 cm/s，337 cm/s。假定在0.2 s时刻的血管状态下分别使用两种方法实施取栓，如图3E所示，“由近及远吸栓法” 的吸栓导管随着慢慢靠近血栓，其管腔内血液流速逐渐降低，直至停止。“由远及近吸栓法” 的吸栓导管送入到血栓远端后，边退边吸，开始导管内有少许血流，血流较慢，当导管退到0 mm处后，其管腔内血流速度逐渐增高。在4-0.25 mm的5个模型中比较两种吸栓方法的导管内血流速度最大值，统计方法采用配对t检验，结果提示差异有显著性意义(P < 0.01，表2)，显示在4-0.25 mm范围内“由近及远吸栓法” 导管内血流速度最大值较“由远及近吸栓法”更大。 2.4 Penumbra机械取栓的18个流固耦合模型的血流压力降分布情况如图4所示，观察每个模型在心动周期不同时刻血液压力降分布情况发现：①“由近及远吸栓法”的各模型大脑中动脉血管残端腔内压力均较高，接近于颈内动脉；吸栓导管颅内段腔内压力为-40-50 kPa，而血液压力陡然下降的部位为吸栓导管开口。②“由远及近吸栓法” 的各模型大脑中动脉血管残端腔内压力也接近于颈内动脉，但吸栓导管位于-3-0 mm时，导管腔内压力很低，接近-70 kPa，当导管退回到大脑中动脉血管残端腔内时，导管内压力有所上升，远端血管血压亦有所上升，但血液压力下降最迅速的部位仍为吸栓导管开口。 2.5 Penumbra机械取栓的18个流固耦合模型的血管壁和血栓壁面切应力分布 2.5.1 左侧大脑中动脉血管壁壁面切应力分布观察18个流固耦合模型的血管壁壁面切应力分布图发现，每个模型左侧大脑中动脉血管壁壁面切应力均不高，其值为 1-60 Pa(图4B，C，D)。其中“由近及远吸栓法”0.25 mm模型在0.2 s时血栓近端附近的血管壁的H点局部达最大值(图4B)；“由远及近吸栓法”0.25 mm模型在0.2 s时血栓近端附近的血管壁的J点局部达最大值(图4D)，该吸栓法的0至-3 mm模型血栓远端血管管壁壁面切应力极低，为 1-5 Pa(图4C下图)。由于两种吸栓法的0.25 mm模型均计算了5个周期，H点和J点每个周期均在0.2 s时达局部最大值，计算5个周期H点和J点最大值的均值，比较2个模型均值之间差异，经过t 检验提示差异有显著性意义(P < 0.01，表2)，显示J点最大值高于H点最大值。 2.5.2 血栓壁面切应力分布观察18个流固耦合模型的血栓壁面切应力分布图发现，其值范围较大，为1-420 Pa (图4B，D)。在“由近及远吸栓法”的4 mm，2 mm，1 mm，0 mm模型中血栓壁面切应力较小，整体小于10 Pa，但在0.5 mm，0.25 mm模型中血栓壁面切应力明显增高，甚至高于400 Pa，其中0.25 mm模型在0.2 s时在I点达到局部最大值(图4B)。在“由远及近吸栓法”的4-1 mm，0至-3 mm模型中血栓壁面切应力也较小，整体也小于10 Pa，在 0.5 mm，0.25 mm模型中血栓壁面切应力也明显增高，其中0.25 mm模型在0.2 s时在K点达到局部最大值(图4D)。由于两种吸栓法的0.25 mm模型均计算了5个周期，I点和K点每个周期均在0.2 s时达局部最大值，计算5个周期I点和K点最大值的均值，比较2个模型均值之间差异，经过t检验提示差异有显著性意义(P < 0.01)，见表2，显示I点最大值明显高于K点最大值。 "

2.6 Penumbra机械取栓的18个流固耦合模型的血管壁和血栓变形情况 2.6.1 左侧大脑中动脉残端血管壁变形情况观察每个模型整个心动周期左侧大脑中动脉残端管壁变形图，每个模型均在0.22 s时刻管壁变形量最大。比较每个模型在0.22 s时刻的左侧大脑中动脉残端管壁变形量最大值发现：①在“由近及远吸栓法”的4-0 mm模型残端管壁变形量最大值均较小，不超过1.5 mm(图5A左图)；在“由远及近吸栓法”的4-0.25 mm模型残端管壁变形量最大值也较小，而在-3-0 mm模型中血栓远端的血管壁变形量较大(图5A右图的R点)。②其中“由近及远吸栓法”的0.25 mm模型在0.22 s时局部最大值是该方法所有模型的管壁变形量最大值；“由远及近吸栓法”的-2 mm模型在0.22 s时血栓远端的血管壁变形量是本法所有模型的管壁变形量最大值；这两个最大值均计算了5个周期，分别取均值，两最大值的均值之间经过t检验提示差异有显著性意义(P < 0.01) (表2)，显示“由远及近吸栓法”的血管壁变形量明显大于“由近及远吸栓法”。 2.6.2 血栓变形情况观察每个模型整个心动周期血栓变形图，每个模型血栓变形量受心跳影响较小，整个心动周期其值几乎不变。如图5B图所示，“由近及远吸栓法”的4-0.25 mm模型血栓变形量较小，小于1.0 mm，在0 mm 模型达最大值，最大值位于血栓近心段M点附近(图5A)；“由远及近吸栓法”的4-0.25 mm，-1.5至-3 mm模型血栓变形量也较小，小于1.0 mm，但在0 mm，-0.5 mm，-1 mm模型血栓变形量值均较大，其中-1 mm模型达本法的最大值，最大值位于血栓远心段N点附近(图5A)。比较两种吸栓方法所得血栓变形量最大值，均计算了5个周期，分别取均值，两最大值的均值之间经过t检验提示差异有显著性意义(P < 0.05)，见表2，显示“由远及近吸栓法”的血栓变形量明显大于“由近及远吸栓法”。 "

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