Patient-Specific Simulations to Guide Coronary Bifurcation Stenting

指导冠状动脉分叉支架置入的患者特异性模拟

• 批准号: 9762418
• 负责人: Ioannis S Chatzizisis
• 金额: $ 82.42万
• 依托单位: UNIVERSITY OF NEBRASKA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-15 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9762418
• 关键词: Anatomy; Atlases; Biology; Biomechanics; Blinded; Blood Vessels; Cardiac; Cardiology; Carotid Arteries; Cations; Cause of Death; Clinical; Complex; Computer Simulation; Coronary; Coronary Arteriosclerosis; Data; Dilatation - action; Dimensions; Environment; Event; Family suidae; Female; Finite Element Analysis; Goals; Human; Implant; Infrastructure; Instruction; Intervention; Lesion; Liquid substance; Manufacturer Name; Mechanics; Modeling; Modification; Multi-Institutional Clinical Trial; Outcome; Patients; Performance; Plant Roots; Protocols documentation; Randomized Controlled Trials; Research; Role; Sample Size; Side; Societies; Solid; Stents; Stress; Tail; Techniques; Testing; Time; Training; Translating; Work; clinically relevant; design; hemodynamics; improved; improved outcome; innovation; interest; male; novel; percutaneous coronary intervention; personalized approach; post intervention; precision medicine; prevent; prospective; randomized trial; restenosis; shear stress; simulation; structural heart disease; success; tool; treatment strategy; vascular bed

PROTOCOL SUMMARY/ABSTRACT Coronary artery disease is the leading cause of death in Western society. Stents are implanted in 70-90% of the 1.3 million percutaneous coronary interventions performed annually in the USA, of which 20% involve bifurcations. Coronary bifurcations remain one of the most challenging lesion subsets in interventional cardiology, with a lower procedural success rate and increased rates of long-term adverse cardiac events, ranging between 15-20% at six months to one year post-intervention. Despite the great interest in this complex lesion subset, percutaneous treatment of coronary bifurcations is still a controversial subject and multiple technical strategies have been proposed. Fundamental mechanical disturbances within the stent appear to be major determinants of stent restenosis. No two bifurcations are identical, and no single treatment strategy exists that can be applied to every bifurcation. The most important issue in bifurcation interventions is selecting the most appropriate strategy for a specific bifurcation. Accordingly, we intend to investigate for the first time in human the role of fluid stresses on stent restenosis. We will use a validated subject-specific finite element analysis of arterial bifurcations rooted in clinical and experimental data to faithfully predict stent restenosis. The overall objective of this proposal is to use an individualized approach to identify the optimal bifurcation stenting technique for a specific bifurcation. Our central hypothesis is that subject-specific simulations of bifurcation stenting optimize the local biomechanical environment and reduces stent restenosis. Our proposal brings together extensive expertise, infrastructure and preliminary work in fluid and solid mechanics, computational simulations and vascular biology. These findings will establish clinically-relevant hypotheses that will serve as basis for our long term goal; a large, randomized controlled trial to show improved clinical outcomes with patient-specific bifurcation stenting strategies. The proposed research is an example of how precision medicine with pre-procedural planning can help optimize bifurcation stenting and improve clinical outcomes. Patient-specific computational stenting simulations may shift the management paradigm of coronary bifurcation interventions and provide a new dimension on how to improve the stenting and post-dilatation techniques.

协议摘要/摘要 冠状动脉疾病是西方社会死亡的主要原因。支架植入了70-90％ 每年在美国执行的130万经皮冠状动脉干预措施，其中20％涉及 分叉。冠状动脉分叉仍然是介入中最具挑战性的病变子集之一 心脏病学，程序成功率较低，长期不良心脏事件的率提高， 干预后六个月到一年的一年范围在15-20％之间。尽管对这个综合体非常感兴趣 病变子群，冠状分叉的经皮治疗仍然是一个有争议的受试者 已经提出了技术策略。支架内的根本机械干扰似乎是 支架再狭窄的主要决定因素。没有两个分叉是相同的，也没有单一的治疗策略 存在可以应用于每个分叉的。分叉干预中最重要的问题是选择 特定分叉的最合适策略。因此，我们打算首次调查 人类流体应激对支架再狭窄的作用。我们将使用经过验证的特定主题有限元素 分析植根于临床和实验数据的动脉分叉，以忠实地预测支架再狭窄。这 该建议的总体目的是使用个性化方法来识别最佳分叉 特定分叉的支架技术。我们的中心假设是对主体的模拟 分叉支架优化局部生物力学环境并减少支架再狭窄。我们的建议 汇集了丰富的专业知识，基础设施和流体和固体力学的初步工作， 计算模拟和血管生物学。这些发现将建立与临床相关的假设 将作为我们长期目标的基础；一项大型随机对照试验，以显示改善的临床 患者特异性分叉支架支架策略的结果。拟议的研究就是一个例子 精密医学和术前计划可以帮助优化分叉支架并改善临床 结果。特定于患者的计算支架模拟可能会改变冠状动脉的管理范式 分叉干预措施，并提供有关如何改善支架和稀释后的新维度 技术。