Hemodynamics in Intracranial Aneurysm Pathogenesis

颅内动脉瘤发病机制中的血流动力学

• 批准号: 8166317
• 负责人: Daniel Marcelo Sforza
• 金额: $ 18.26万
• 依托单位: GEORGE MASON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8166317
• 关键词: Affect; Agreement; Aneurysm; Area; Arteries; Berry Aneurysm; Blood Vessels; Brain Aneurysms; Brain hemorrhage; Cerebral Aneurysm; Clinical; Clinical Management; Clip; Computer Simulation; Consensus; Databases; Development; Diagnosis; Disease; Elements; Environment; Evaluation; Goals; Growth; Health; Human; Image; Intracranial Aneurysm; Investigation; Lateral; Light; Liquid substance; Location; Measures; Modeling; Morphology; Natural History; Neck; Parents; Pathogenesis; Patients; Physiological; Play; Principal Investigator; Probability; Process; Research; Rest; Risk Assessment; Role; Running; Rupture; Site; Stress; Subarachnoid Hemorrhage; Testing; Work; base; experience; hemodynamics; improved; in vivo; in vivo Model; indexing; insight; outcome forecast; programs; simulation; tool; treatment strategy

DESCRIPTION (provided by applicant): Cerebral aneurysm rupture is a leading cause of hemorrhagic strokes. Because cerebral aneurysms are being more frequently diagnosed before they rupture and the prognosis of subarachnoid hemorrhage is still poor, treating clinicians are often required to judge which aneurysms are prone to progression and rupture. Unfortunately our understanding of the natural history of cerebral aneurysms is limited because the processes of aneurysm initiation, growth and rupture are not well understood. In this project we will focus on the initiation process. Despite general consensus that hemodynamic stress plays a fundamental role in the formation of cerebral aneurysms, there is no agreement about which hemodynamic variables are implicated in the underlying mechanisms responsible for aneurysm formation and development. We propose to conduct an exploratory study of the association between the local hemodynamic environment and the initiation site of intracranial aneurysms, with the goal of gaining a deeper insight into the mechanisms of pathogenesis and to identify hemodynamic indices able to localize the sites likely to develop aneurysms. To carry on these investigations we will use image-based computational fluid dynamics (CFD) modeling to represent the in vivo hemodynamics before aneurysm formation. The research will be organized around the following specific aims: 1) select 40 saccular aneurysm geometries with two different morphologies (terminal/bifurcation and lateral/sidewall) and 40 healthy artery geometries matching the aneurysm locations, 2) delete aneurysms to approximate the geometry before aneurysm formation and run CFD simulations for all models under different flow conditions, 3) analyze hemodynamic variables at formation sites and test newly proposed hemodynamic indices as predictors of aneurysm formation sites. This project will not only shed light into the underlying mechanisms governing aneurysm initiation, but also will guide the development of clinical tools for the evaluation and treatment of cerebral aneurysms. PUBLIC HEALTH RELEVANCE: The overall goal of this project is to identify hemodynamic conditions associated to the formation of cerebral aneurysms using patient-specific image-based computational fluid dynamics to model the in vivo hemodynamics prior to the aneurysm initiation. This project will not only help to better understand the pathogenesis but will also attempt to determine which artery sites are most likely to develop aneurysms. The results obtained on this project will have a large impact on the management of intracranial aneurysms by improving risk assessment and treatment.

描述（由申请人提供）：脑动脉瘤破裂是出血性中风的主要原因。由于脑动脉瘤在破裂前得到诊断的频率越来越高，而蛛网膜下腔出血的预后仍然很差，因此治疗临床医生通常需要判断哪些动脉瘤容易进展和破裂。不幸的是，我们对脑动脉瘤自然史的理解是有限的，因为动脉瘤的发生、生长和破裂的过程尚不清楚。在这个项目中，我们将重点关注启动过程。尽管人们普遍认为血流动力学应激在脑动脉瘤的形成中发挥着重要作用，但对于哪些血流动力学变量与动脉瘤形成和发展的潜在机制有关尚未达成一致。我们建议对局部血流动力学环境与颅内动脉瘤起始部位之间的关联进行探索性研究，目的是更深入地了解发病机制，并确定能够定位可能发生动脉瘤的部位的血流动力学指标。为了进行这些研究，我们将使用基于图像的计算流体动力学 (CFD) 建模来表示动脉瘤形成之前的体内血流动力学。该研究将围绕以下具体目标进行组织：1）选择 40 个具有两种不同形态（末端/分叉和侧向/侧壁）的囊状动脉瘤几何形状和 40 个与动脉瘤位置匹配的健康动脉几何形状，2）删除动脉瘤以近似之前的几何形状动脉瘤形成并在不同流动条件下对所有模型运​​行 CFD 模拟，3) 分析形成部位的血流动力学变量并测试新提出的血流动力学指数作为动脉瘤形成部位的预测因子。该项目不仅将揭示控制动脉瘤发生的潜在机制，还将指导开发用于评估和治疗脑动脉瘤的临床工具。 公共健康相关性：该项目的总体目标是使用基于患者特定图像的计算流体动力学来对动脉瘤发生前的体内血流动力学进行建模，从而确定与脑动脉瘤形成相关的血流动力学条件。该项目不仅有助于更好地了解发病机制，还将尝试确定哪些动脉部位最有可能发生动脉瘤。该项目获得的结果将通过改进风险评估和治疗对颅内动脉瘤的管理产生重大影响。