北京生物醫(yī)學(xué)工程

封閉式取栓支架的生物力學(xué)研究

The biomechanical study of the close-type stent retrievers

作者：張曉穎谷雪蓮田浩孟繁鶴邱曉鍵

單位：上海理工大學(xué)醫(yī)療器械與食品學(xué)院(上海 200093) 微創(chuàng)神通醫(yī)療科技(上海)有限公司(上海 201318) 通信作者:谷雪蓮。 E-mail: [email protected]

關(guān)鍵詞：機(jī)械取栓術(shù);封閉式取栓支架;徑向支撐力;回撤力;有限元分析

分類號：R318. 01

出版年·卷·期（頁碼）：2021·40·6（577-583）

摘要：

目的機(jī)械取栓術(shù)(mechanical thrombectomy,MT)是治療急性缺血性腦卒中(acute ischemic stroke,AIS)的有效方法，治療中使用的封閉式取栓支架的結(jié)構(gòu)及力學(xué)特性對手術(shù)效果有重要影響。為了提高取栓支架的安全性及有效性，本研究對封閉式取栓支架的壓握入管、自膨脹釋放和遷移取栓3個階段進(jìn)行生物力學(xué)研究,分析取栓支架結(jié)構(gòu)及其力學(xué)特征。方法首先建立支撐單元個數(shù)不同(3、4、5) 的B3、B4和B5取栓支架的幾何模型，然后建立壓握工具、模擬血管和血栓的有限元模型。在壓握工具的徑向施加位移載荷對取栓支架進(jìn)行壓握;恢復(fù)其位移，使取栓支架自膨脹與血管接觸；再通過在取栓支架的近端施加軸向位移，讓取栓支架帶動血栓進(jìn)行遷移。評價(jià)參數(shù)分別為取栓支架的最大主應(yīng)變及應(yīng)力、取栓支架徑向支撐力、血管Mises應(yīng)力和支架的回撤力。結(jié)果壓握過程中3款封閉式取栓支架的最大主應(yīng)變峰值分別為9. 10%、10.41%和8. 61%,都處于安全范圍內(nèi)。支架外徑為3 mm時(shí)(等于血管內(nèi)徑)，B3支架的徑向支撐力最大。自膨脹釋放過程中，B5支架對血管造成的Mises應(yīng)力值為1.757 MPa,超過了已知的正常血管的極限。遷移取栓階段發(fā)現(xiàn),取栓支架的支撐單元數(shù)越多，對應(yīng)血管的 Mises應(yīng)力值越大;取栓支架的回撤力在遷移取栓的初始階段達(dá)到最大值,后漸漸下降趨于平穩(wěn)，其中 B5支架的回撤力最大。結(jié)論雖然B5支架擁有最大的回撤力，但B3支架在徑向支撐性能、結(jié)構(gòu)完整性能、與血管作用的安全性等方面表現(xiàn)更優(yōu)。該研究結(jié)果可以為取栓支架的結(jié)構(gòu)優(yōu)化設(shè)計(jì)提供一種分析方法，為取栓支架的性能提高提供一些參考。

Objective Mechanical thrombectomy (MT) is an effective method for the treatment of acute

ischemic stroke ( AIS). The structure and mechanical properties of the close-type stent retrievers used in the treatment are related to the therapeutic effect. In order to improve the safety and effectiveness of stent retrievers, this study carries out biomechanical analysis on the three stages of close-type stent retrievers: compression and insertion tube, self-expanding release, and migration thrombus removal, and analyzes the structure and mechanical characteristics of the stent retrievers. Methods First,we established finite element models of B3 ,B4 and B5 stent retrievers with different supporting cells (3, 4,5) ,and then established finite element models of crimping tools,simulated blood vessels and thrombus. We applied displacement load on the radial direction of the crimping tool to crimp the stent retrievers, restored displacement to make the stents self-expand and contact the blood vessel, and then applied axial displacement at the proximal end of the stent retrievers to make the thrombus to migrate. The evaluation parameters are the maximum principal strain ( MPS) and von Mises stress ( VMS) of the stent retrievers, the radial force of the stent retrievers, the vascular VMS and the stent withdrawal force. Results During the crimping process, the MPS peaks of the three close-type stent retrievers were 9. 10% , 10. 41%, and 8. 61%, which were all within the safe range. When the outer diameter of the stent was 3 mm ( equal to the inner diameter of the blood vessel) ,the B3 stent' s radial force was the largest. During the self-expanding and release process, the VMS caused by the B5 stent to the blood vessel was 1. 757 MPa,which exceeded the limit of normal blood vessels. It was found in the migration and removal stage that the larger the number of support cells, the greater the VMS of the corresponding blood vessel. The withdrawal force of the stents reached the maximum value at first, then gradually decreased. The withdrawal force of the B5 stent was the largest. Conclusions Although the B5 stent has the largest withdrawal force ,the B3 stent performs better in terms of radial support performance, structural integrity, and safety in vascular interaction. The research results can provide an analysis method for the structural optimization design of the close-type stent retrievers, and certain references for the performance improvement of the close-type stent retrievers.

參考文獻(xiàn)：

[1 ]魏社鵬.腦卒中和腦血管病[M], ±海：同濟(jì)大學(xué)出版社, 2018.

Wei SP. Stroke and cerebral vascular disease [ M ]. Shanghai: Tongji University Press,2018.

[2 ] Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics—2018 update: a report from the American Heart Association [ J]. Circulation,2018,137( 12) :e67—e492.

[3]中國老年醫(yī)學(xué)學(xué)會急診醫(yī)學(xué)分會，中華醫(yī)學(xué)會急診醫(yī)學(xué)分會卒中學(xué)組，中國卒中學(xué)會急救醫(yī)學(xué)分會.急性缺血性腦卒中急診急救中國專家共識(2018) [ J],臨床急診雜志,2018, 19 (6) ：351-359.

[4 ] Bose A, Henkes H, Alike K, et al. The penumbra system: A mechanical device for the treatment of acute stroke due to thromboembolism [ J ] . American Journal of Neuroradiology, 2008,29(7):1409-1413.

[5 ] Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct [J]. The New England Journal of Medicine, 2017,378 ( 1 )： 11-21.

[6 ] Appireddy R, Assis Z, Goyal M. Mechanical thrombectomy: new era of stent retriever [ M ]// Stroke revisited: diagnosis and treatment of ischemic stroke. Singapore: Springer, Singapore, 2017：71-100.

[7 ]周新，譚偉，張斌，等.鐐鈦形狀記憶合金壓縮力學(xué)行為及其密封性能[J].科學(xué)技術(shù)與工程,2018,18(19):33-37.

Zhou X,Tan W,Zhang B,et al. Compressive mechanical behavior and sealing property of NiTi shape memory alloy [ J]. Science Technology and Engineering,2018,18(19) ：33-37.

[8 ] Machi P, Costalat V, Lobotesis K, et al. Solitaire FR thrombectomy system: immediate results in 56 consecutive acute ischemic stroke patients [ J ]. Journal of Neurolnterventional Surgery ,2012,4： 62-66.

[9 ]劉國榮，潘曉華,劉秀珍，等.機(jī)械取栓并發(fā)癥的相關(guān)因素分析[J].臨床神經(jīng)病學(xué)雜志,2019,32(4)=278-281.

Liu GR, Pan XH, Liu XZ, et al. Analysis of related factors of complications of mechanical thrombectomy complications [ J ]. Journal of Clinical Neurology,2019,32(4) ：278-281.

[10] Uchikawa H, Kuroiwa T, Nishio A, et al. Vasospasm as a major complication after acute mechanical thrombectomy with stent retrievers [ J] . Journal of Clinical Neuroscience : official journal of the Neurosurgical Society of Australasia,2019,64： 163-168.

[11 ] Yub Lee S, Won?Youn S, Kyun Kim H, et al. Inadvertent detachment of a retrievable intracranial stent: review of manufacturer and user facility device experience [ J ]. The Neuroradiology Journal,2015,28(2) ； 172—176.

[12]?Arai D, Ishii A, Chihara H, et al. Histological examination of vascular damage caused by stent retriever thrombectomy devices [J]. Journal of Neurolnterventional Surgery, 2016,8( 10) ：992.

[13]?Yi HJ, Sung JH, Lee DH, et al. Single-center experience of mechanical thrombectomy with the Trevo XP Pro Vue 6 X 25 mm stent retriever in middle cerebral artery occlusion: comparison with Trevo XP ProVue 4 x 20 mm [ J ]. World Neurosurgery, 2017,107： 649-656.

[14]?Kleinstreuer C, Li Z, Basciano CA, et al. Computational mechanics of Nitinol stent grafts [ J]. Journal of Biomechanics, 2008,41(11)：2370-2378.

[15]?Gu X,Qi Y,Erdman A,et al. The role of simulation in the design of a semi-enclosed tubular embolus retrieval [ J ]. Journal of Medical Devices,2017,11(2) ：0210011-0210017.

[16]?劉波，謝鵬，李志偉.急性腦栓塞Penumbra機(jī)械取栓：1例建模和有限元分析[J].中國組織工程研究，2014, 18(27)： 4345-4354.

Liu B, Xie P, Li ZW. 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.

[17]?Chueh JY, Wakhloo AK, Hendricks GH, et al. Mechanical characterization of thromboemboli in acute ischemic stroke and laboratory embolus analogs [ J ] . American Journal of Neuroradiology,2011,32(7) : 1237—1244.

[18]?Kleinstreuer C,Li Z,Basciano CA,et al. Computational mechanics of nitinol stent grafts [ J ]. Journal of Biomechanics, 2008, 41 (11) ： 2370-2378.

[19]?Monson KL, Goldsmith W, Barbara NM, et al. Axial mechanical properties of fresh human cerebral blood vessels [ J ]. Journal of Biomechanical Engineering,2003,125(2) :288-294.

[20]?Machi P,Jourdan F, Ambard D,et al. Experimental evaluation of stent retrievers ' mechanical properties and effectiveness [ J ]. Journal of Neurolnterventional Surgery,2017,9(3) :257—263.

[21]?張成超，郭連瑞,谷涌泉，等.補(bǔ)救性支架在脾動脈瘤介入治療中的應(yīng)用體會1例[J].中國醫(yī)藥導(dǎo)報(bào),2020, 17 (2)： 173-176.

Zhang CC,Guo LR,Gu YQ,et al. Application of salvage stent in interventional treatment of splenic aneurysm: a case report [ J ]. China Medical Herald,2020,17(2) ： 173-176.

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