Predicting cerebral aneurysm recurrence using Doppler guidewire measurements

使用多普勒导丝测量预测脑动脉瘤复发

基本信息

批准号：
8837335
负责人：
Louis Joong Kim
金额：
$ 32.99万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-01 至 2019-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8837335
关键词：
Accounting Affect Aftercare Aneurysm Angiography Blood Flow Velocity Blood Pressure Blood Vessels Blood flow Brain Brain hemorrhage Cerebral Aneurysm Cerebral Angiography Cerebrovascular Circulation Cerebrum Cessation of life Characteristics Clinical Treatment Computer Simulation Data Decision Making Doctor of Philosophy Engineering Environment Failure Funding Goals Healed Health Care Costs Hospitalization Image Institutional Review Boards Intracranial Aneurysm Investigation Knowledge Life Location Measurement Measures Mechanics Medical center Methodology Methods Modeling Neurosurgeon North America Outcome Patients Physicians Play Predictive Value Prevalence Prospective Studies Publishing Recurrence Research Research Methodology Retreatment Risk Role Specific qualifier value Staging Stents Stress Techniques Technology Testing Time Translational Research Treatment Efficacy Treatment Failure Treatment outcome United States National Institutes of Health blood flow measurement clinical practice cohort computerized disability follow-up healing hemodynamics improved in vivo innovation novel outcome forecast prevent public health relevance sensor success treatment effect treatment strategy

项目摘要

DESCRIPTION (provided by applicant): Here we seek to identify how hemodynamic factors influence the success or failure of cerebral aneurysm treatment, and measure such factors at the time of treatment in an attempt to improve treatment outcome and prevent brain hemorrhage. This goal is significant due to the prevalence of cerebral aneurysms, which account for over 30,000 life-threatening brain hemorrhages in North America every year, with a dismal prognosis. While aneurysm treatment has advanced rapidly, treatment failure rates (resulting in aneurysm recurrence and risk of either brain hemorrhage or need for retreatment) approach 34%. Hemodynamic forces are thought to influence aneurysm treatment success, but the accurate modeling of such forces has not been incorporated into clinical practice and treatment decision-making. Doing so could improve the efficacy of aneurysm treatment, reducing death and disability as well as health care costs associated with multiple hospitalizations. We will build on our previous NIH-funded, IRB-approved study using a Doppler-tipped guidewire to collect in vivo measurements of patients' blood flow velocity (BFV) and blood pressure in brain blood vessels harboring intracranial aneurysms. We have previously shown that incorporating patient-specific measurements using this technique is safe, feasible and significantly more accurate than traditional methods of hemodynamic modeling. By measuring such characteristics at the time of treatment, we can characterize the treatments' hemodynamic effects. We then observe a cohort of patients over time, classifying those with either treatment success (aneurysm healing) or failure (aneurysm recurrence or persistence). By identifying which hemodynamic changes after treatment are associated with treatment failure, we can then prospectively screen new patients for such factors at the time of initial treatment, predicting which aneurysms might recur. This project has two stages of investigation. First, we will define the immediate hemodynamic effects of endovascular treatments of cerebral aneurysms. We will use computational modeling that incorporates patient- specific, individualized invasive measurements of BFV and blood pressure in precise anatomical locations obtained with the Doppler-tipped guidewire, which improves the accuracy of such calculations. Second, we will obtain follow-up imaging of the cerebral vasculature at least six months after treatment, and identify whether patients' aneurysms were successfully treated. We will then retrospectively compare the initial, immediate post-treatment hemodynamics between those patients whose aneurysms failed treatment and those that healed, and determine the threshold at which important hemodynamic factors correspond to treatment efficacy. Second, we will prospectively screen patients for such factors during aneurysm treatment to identify patients at risk of treatment failure. By prospectively applying the results of stage 1 to a new cohort of patients, we can predict whether aneurysms with particular hemodynamic changes immediately after treatment will either heal or recur at long-term follow-up.

描述（由申请人提供）：在这里，我们试图确定血液动力学因素如何影响脑动脉瘤治疗的成功或失败，并在治疗时测量这些因素，以改善治疗结果并预防脑出血。由于脑动脉瘤的普遍性，该目标是重要的，该脑动脉瘤的患病率每年在北美造成超过30,000次危及生命的大脑出血，并预后令人沮丧。虽然动脉瘤治疗迅速发展，但治疗衰竭率（导致动脉瘤复发和脑出血或需要恢复需要）34％。人们认为血液动力学会影响动脉瘤的成功，但是这种力的准确建模尚未纳入临床实践和治疗决策中。这样做可以提高动脉瘤治疗的功效，减少死亡和残疾以及与多个住院相关的医疗费用。我们将使用以前的NIH资助，IRB批准的研究，使用多普勒尖端的指导线来收集患者血流速度（BFV）的体内测量和具有颅内动脉瘤的脑血管中的血压。我们先前已经表明，使用此技术合并患者特异性测量值是安全，可行的，并且比传统的血液动力学建模方法更准确。通过在治疗时测量此类特征，我们可以表征治疗的血液动力学作用。然后，随着时间的流逝，我们观察到一群患者，对患者（动脉瘤愈合）或衰竭（动脉瘤复发或持久性）进行分类。通过确定治疗后哪些血液动力学变化与治疗失败有关，我们可以在初次治疗时前瞻性地筛查新患者的此类因素，以预测哪些动脉瘤可能会复发。该项目有两个调查阶段。首先，我们将定义脑动脉瘤血管内治疗的直接血流动力学作用。我们将使用计算建模，其中包含了患者特异性的，个性化的BFV和血压的侵入性测量，并在用多普勒尖端的Guidewire获得的精确解剖位置中，这提高了此类计算的准确性。其次，我们将在治疗后至少六个月后获得脑脉管系统的后续成像，并确定是否成功治疗患者的动脉瘤。然后，我们将回顾性比较那些动脉瘤失败治疗的患者与愈合的患者之间的初始治疗后血液动力学，并确定重要的血液动力学因子对应于治疗疗效的阈值。其次，我们将前瞻性地筛查患者在动脉瘤治疗期间的这些因素，以识别患有治疗衰竭风险的患者。通过前瞻性应用第1阶段的结果对新的患者队列，我们可以预测治疗后具有特定血液动力学变化的动脉瘤是否会在长期随访中愈合或复发。