Computational and Biological Approach to Flow Diversion

分流的计算和生物学方法

基本信息

批准号：
8533042
负责人：
Ramanathan Kadirvel
金额：
$ 50.03万
依托单位：
MAYO CLINIC ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-20 至 2016-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8533042
关键词：
Aftercare Aneurysm Animal Model Anticoagulants Arteries Binding Proteins Biocompatible Materials Biological Biological Process Blood Vessels Brain Aneurysms Capsid Proteins Case Series Cell Proliferation Chronic Communities Computer Simulation Coupled Coupling Development Devices Dose Endothelial Cells Evaluation Frequencies Future General Population Goals Healed Histologic Image Implant Individual Interdisciplinary Study Intracranial Aneurysm Knowledge Lead Liquid substance Marketing Measurement Metric Microarray Analysis Modeling Modification Molecular Morphology Neck Oryctolagus cuniculus Outcome Parents Patient Care Patients Perforating Artery Pharmaceutical Preparations Platinum Population Recurrence Research Research Personnel Research Proposals Retreatment Risk Role Rupture Ruptured Aneurysm Safety Series Speed Spontaneous Rupture Stem cells Stroke Structure System Techniques Therapeutic Embolization Thrombosis Thrombus Time Tissues Translational Research Work brain surgery cell motility clinical application clinically relevant cost density healing hemodynamics implantation improved in vivo minimally invasive novel strategies preclinical evaluation primary outcome programs research study response tool treatment planning treatment response virtual

项目摘要

DESCRIPTION (provided by applicant): The long term objective of this research program is to improve the care of patients harboring unruptured brain aneurysms. These aneurysms, present in approximately 2% of the population, may undergo spontaneous rupture with devastating consequences. Recent advances in minimally invasive treatments have allowed many patients to avoid open brain surgery. Unfortunately, these newer treatments often result in imperfect closure of the aneurysm, requiring additional treatments. A recently developed technique, called intraluminal flow diversion, has shown remarkable promise in treating even large or giant aneurysms, which are not well treated with any other technique. Notwithstanding promising results from small series of treated patients, many important questions about these new devices remain unanswered. First, practitioners have no concrete information on how to choose device size or number of devices in order to achieve aneurysm cure; addition of "unnecessary" devices increases risk to patients and thus knowledge about the "ideal" device for a given patient would be an important step forward. Second, the actual reasons behind why these flow diverters result in aneurysm cure remain unknown; advancing our knowledge of how they actually function would not only help individual patients but also speed development of improved devices. Third, a number of patients treated with these devices have suffered unexpected and usually fatal rupture of the aneurysm after treatment, which has convinced many practitioners either to avoid the use of flow diverters altogether or to use, at the same time, coil treatment in the aneurysm; adding the coil therapy increases both cost and risk, and thus understanding the reasons behind these rare but devastating ruptures would improve patient care. Finally, all patients treated with these devices require long term treatment with blood thinning medications; improvements in the device to avoid this need would decrease overall risk. The experiments outlined in this proposal include the latest advances in computer-based simulations of aneurysm flows, both before and after treatment, coupled with use of a widely-studied animal model. Study of these experimental systems will allow us to answer each of the important questions listed above, with the long term objective of safely and permanently curing brain aneurysms.

描述（由申请人提供）：该研究计划的长期目的是改善携带脑动脉瘤不破裂的患者的护理。这些动脉瘤大约存在于大约2％的人群中，可能会出现自发破裂而造成毁灭性后果。微创疗法的最新进展使许多患者避免了脑部手术。不幸的是，这些较新的治疗方法通常会导致动脉瘤的闭合，需要其他治疗。最近开发的一种称为腔内流动转移的技术在处理大型或巨型动脉瘤方面表现出了巨大的希望，这些动脉瘤也无法通过任何其他技术进行很好的处理。尽管有一系列经过治疗的患者的有希望的结果，但有关这些新设备的许多重要问题仍未得到答复。首先，从业者没有有关如何选择设备尺寸或设备数量的具体信息，以实现动脉瘤治疗；添加“不必要的”设备会增加患者的风险，因此，对给定患者的“理想”设备的了解将是重要的一步。其次，为什么这些流动分开导致动脉瘤治疗的实际原因仍然未知。促进我们对它们实际运作的了解不仅会帮助单个患者，还可以加快改进设备的开发。第三，许多接受这些设备治疗的患者在治疗后遭受了障碍性动脉瘤的意外且通常致命的破裂，这使许多从业人员避免完全使用流动分流器，或者同时使用流动率处理。添加线圈疗法会增加成本和风险，从而了解这些罕见但毁灭性破裂的原因将改善患者护理。最后，所有接受这些设备治疗的患者都需要长期治疗血液稀疏药物。设备的改进以避免这种需求会降低总体风险。该提案中概述的实验包括在治疗前后对基于计算机的动脉瘤流的最新进展，再加上使用广泛研究的动物模型。对这些实验系统的研究将使我们能够回答上面列出的每个重要问题，并具有安全和永久治愈大脑动脉瘤的长期目标。