Percutaneous cardiac HIFU ablation with multimodal image guidance

多模态图像引导经皮心脏 HIFU 消融

• 批准号: 8575464
• 负责人: BUTRUS T KHURI-YAKUB
• 金额: $ 75.88万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8575464
• 关键词: Ablation; Address; Affect; Age; American; Animal Model; Animals; Area; Arrhythmia; Atrial Fibrillation; Biomedical Research; Cardiac; Cardiovascular system; Chest; Clinical; Development; Devices; Doctor of Philosophy; Effectiveness of Interventions; Electronics; Electrophysiology (science); Esophagus; Excision; Family suidae; Feasibility Studies; Focused Ultrasound Therapy; Frequencies; General Population; Goals; Grant; Heart; Heart Diseases; Heating; Human Resources; Image; Institution; Intervention; Lesion; Magnetic Resonance Imaging; Maps; Medicine; Methods; Minimally Invasive Surgical Procedures; Modality; Modeling; Monitor; Multimodal Imaging; Myocardium; Operative Surgical Procedures; Pattern; Pharmaceutical Preparations; Population; Prevalence; Procedures; Pulmonary veins; Radio; Radiofrequency Interstitial Ablation; Recurrence; Research; Scheme; Series; Site; Stroke; Structure of phrenic nerve; Surgical incisions; System; Technology; Testing; Therapeutic; Thigh structure; Time; Tissue Sample; Tissues; Transducers; Trocars; Ultrasonic Transducer; Ultrasonography; Uterine myomectomy; Work; base; design; experience; improved; in vivo; in vivo Model; miniaturize; minimally invasive; operation; photoacoustic imaging; programs; prototype; public health relevance; tool

DESCRIPTION (provided by applicant): Atrial fibrillation (AF) is the most common type of cardiac arrhythmia, with an estimated prevalence of 0.4% to 1% in the general population, increasing with age (8% for people over 80). In addition to drug treatments, electrophysiology-based treatment modalities such as ablation treatment are wide employed for arrhythmias. To treat the AF the most common anatomical target for ablation is the entrance of pulmonary veins and the surrounding tissue. Currently, radio-frequency (RF) energy is generally used to ablate the described sites in the heart. It is difficult to control the ablation pattern using RF ablation which also has limitations in creating deep lesions. If the total electrical isolation in cardiac tissue cannot be achieved, recurrence becomes highly likely. High-intensity focused ultrasound (HIFU) methods have been attempted lately for pulmonary vein isolation, mainly motivated by the promise of creating deep and controlled ablation patterns. However, these attempts suffered from a lack of direct imaging guidance and consequently collateral damage in surrounding tissues such as the phrenic nerve and the esophagus. The well-known shortcomings of RF ablation methods and the limitations presented by the early HIFU results clearly indicate the need for a system that integrates image guidance with effective and well-controlled ablation methods. We propose to develop devices and systems to address the summarized issues. In our proposed scheme, conventional ultrasound imaging is used for anatomical guidance and target identification, HIFU for tissue ablation, and photoacoustic imaging for monitoring lesion formation. The proposed device is based on the capacitive micromachined ultrasonic transducer (CMUT) technology. CMUTs are proven to have minimal self-heating in continuous wave operation, unlike their piezoelectric counterparts with high internal dielectric losses. This self-heating of piezoelectric transducers was partly responsible for the collateral damage experienced in early cardiac HIFU attempts. CMUTs can also be implemented in large arrays that are suitable for dual imag- ing/therapeutic operation. The specific aims of the proposed work are as follows: 1) Develop a large-scale prototype (15-mm footprint) CMUT array for use in initial feasibility studies and a clinically suitable, small-scale (7-mm footprint) CMUT array integrated with supporting frontend circuits and backend systems, capable of HIFU delivery combined with ultrasound and photoacoustic imaging. 2) Conduct initial feasibility studies on ex-vivo tissue samples and in-vivo open-chest and open-thigh animal models using system subcomponents to determine optimal parameters for both HIFU ablation and photoacoustic imaging. 3) Conduct cardiac studies in the porcine model utilizing the miniaturized integrated probe (7-mm footprint) utilizing a closed chest, minimally invasive model for insertion of the probe through a small incision through the intercostal space.

描述（由申请人提供）：房颤（AF）是最常见的心律失常类型，普通人群的估计患病率为0.4％至1％，随着年龄的增长而增加（80岁以上的人为8％）。除药物治疗外，基于电生理学的治疗方式（例如消融治疗）受到心律不齐的广泛使用。为了治疗AF的消融最常见的解剖靶标是肺静脉和周围组织的入口。当前，射频（RF）能量通常用于消除心脏中所述的位点。很难使用RF消融来控制消融模式，RF消融在产生深层病变方面也有局限性。如果无法实现心脏组织中的总电分离，则很可能复发。最近尝试了肺静脉隔离的高强度聚焦超声（HIFU）方法，这主要是由于建立深层和控制的消融模式的承诺而动机。但是，这些尝试遭受了缺乏直接成像引导的损失，因此在周围的组织（例如神经神经和食道）周围的组织中造成了附带损害。 RF消融方法的众所周知的缺点以及早期HIFU结果提出的局限性清楚地表明，需要将图像指导与有效且控制良好的消融方法整合在一起的系统。我们建议开发设备和系统来解决摘要问题。在我们提出的方案中，常规超声成像用于解剖学指导和靶标识别，组织消融的HIFU以及用于监测病变形成的光声成像。所提出的设备基于电容性微机械超声传感器（CMUT）技术。事实证明，与其内部介电损失高的压电相对，CMUT在连续的波动过程中具有最小的自加热。压电传感器的这种自动加热是对早期心脏HIFU尝试中造成的附带损害的部分原因。 CMUT也可以在适合双重想象/治疗操作的大型阵列中实现。拟议工作的具体目的如下：1）开发一个大型原型（15毫米足迹）CMUT阵列，用于最初的可行性研究，以及一个临床适当的小型（7毫米足迹）CMUT ARRAY与支持前端电路和后端系统相结合的临床小型（7毫米足迹）CMUT ARRAY，可与Hifu Compleance coptry for Molfersosine and toploghocousd and Photosocousd and Photosocousd Impocoustic Importic Impocoustic Impocoustic Impocoustic Impocount Implocoust Implocoustic Implocoust Implocoust Implocoust Implocoust and。 2）使用系统亚组件对前体组织样品和体内开放式和开放式动物模型进行初步可行性研究，以确定HIFU消融和光声成像的最佳参数。 3）利用封闭的胸部，微创模型的微型综合探针（7毫米足迹）在猪模型中进行心脏研究，以通过较小的切口通过肋间空间插入探针。