Mechanical characterization of carotid plaques for stroke risk assessment

用于中风风险评估的颈动脉斑块的机械特征

• 批准号: 10735746
• 负责人: Elisa E. Konofagou
• 金额: $ 75.48万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10735746
• 关键词: Affect; American Heart Association; Anatomy; Animals; Arterial Fatty Streak; Biological Markers; Biomechanics; Biometry; Blinded; Blood Vessels; Blood flow; Carotid Artery Plaques; Cause of Death; Characteristics; Clinical; Detection; Diagnosis; Endarterectomy; Ensure; Family suidae; Fatality rate; Hemorrhage; Histologic; Hospitalization; Image; Imaging Techniques; Intervention; Ischemic Stroke; Lipids; Liquid substance; Magnetic Resonance Imaging; Maps; Mechanics; Medicine; Methodology; Modality; Morphologic artifacts; Neurologist; Neurology; Neurosurgeon; Operative Surgical Procedures; Pathology; Patients; Performance; Persons; Physiologic pulse; Pliability; Property; Radiation; Radiology Specialty; Reader; Recurrence; Reporting; Risk; Risk Assessment; Role; Rupture; Solid; Staging; Stenosis; Stroke; Stroke prevention; Systole; Techniques; Technology; Testing; Ultrasonography; United States; Validation; arterial stiffness; calcification; clinical practice; diagnostic value; disability; elastography; experience; falls; high risk; imaging biomarker; in vivo; intimal medial thickening; multidisciplinary; new technology; porcine model; quantitative imaging; screening; simulation; statistics; stroke event; stroke patient; stroke risk; stroke therapy; symptomatology; tool; ultrasound; vector

Stroke is the fifth leading cause of death and the primary cause of preventable disability and hospitalization in the U.S according to the most recent statistics by the American Heart Association. Each year, approximately 795,000 people continue to experience a new or recurrent stroke. On average, every 40 seconds, someone in the United States has a stroke, and someone dies of one approximately every 4 minutes. This high fatality rate is partly due to the fact that state-of-the-art methodologies such as CT, MRI and ultrasound are currently failing to inform timely intervention. Identification of patients with high-risk, asymptomatic carotid plaques despite their low stenoses remains thus an elusive but essential step in stroke prevention. In current clinical practice, the risk assessment of carotid plaque rupture is based on the degree of intima- media thickness (IMT) and endoluminal stenosis despite the fact that they do not necessarily correlate with vulnerable plaques or subsequent rupture. Current clinical modalities fall thus short in informing on plaque stability. Reliable information on plaque stability would ensure timely treatment, especially in asymptomatic or low endoluminal stenosis patients whose stroke risk remains severely underdiagnosed. Such information shown to be critical but clinically unavailable lies in the plaque compliance and the associated blood flow. Lipid plaques (which are typically less stable and are associated with ischemic stroke) have been shown to have distinct stiffness from calcified plaques. Increased arterial stiffness has also been reported in stroke patients. The objective of the proposed study is thus to amplify the role of carotid sonography by optimizing the combined PWI and VFI methodologies (PWI+VFI) and quantifying the biomarkers of compliance and flow in order to provide critical biomechanical information on plaque stability. In reported studies, our group has shown that plaque characterization in large animals and stroke patients can be achieved. We have demonstrated that PWI+VFI is capable of characterizing carotid plaques based on their distinct stiffness and flow. In this study, we aim towards the characterization of carotid plaques for the ultimately reliable assessment of ischemic stroke risk based on plaque wall and flow biomarkers. We thus hypothesize that PWI can significantly reinforce the diagnostic capability of a conventional vascular ultrasound. The team assembled is highly multi-disciplinary encompassing expertise in ultrasound imaging, biomechanics, vascular radiology, pathology, neurology, vascular surgery and biostatistics. Following the proposed studies, this highly translational technology could be readily integrated in a standard sonogram to accurately inform carotid plaque stability and thus subsequent timely treatment.

中风是死亡的第五大原因，也是可预防残疾的主要原因 根据美国心脏的最新统计数据在美国住院 协会。每年，大约有795,000人继续体验新的或经常性的 中风。平均每40秒钟，美国的某人中风，有人 大约每4分钟死亡。这种高死亡率部分是由于以下事实 CT，MRI和Ultrasound等最先进的方法目前未能通知 及时干预。鉴定尽管 因此，他们的低降压剂仍然是预防中风的难以捉摸但必不可少的一步。目前 临床实践，颈动脉斑块破裂的风险评估是基于内膜的程度 媒体厚度（IMT）和内部狭窄 与脆弱的斑块或随后的破裂相关。当前的临床方式下降因此很短 在通知斑块稳定性时。有关斑块稳定性的可靠信息将确保及时 治疗，尤其是在无症状或低腔内狭窄患者中的治疗 仍然严重诊断。这些信息显示至关重要，但在临床上不可用 位于斑块依从性和相关的血流。脂质斑块（通常是 稳定较低，与缺血性中风有关）已证明具有明显的刚度 从钙化的斑块中。中风患者的动脉僵硬度也增加。这 因此，拟议的研究的目的是通过优化颈动脉超声检查的作用 合并的PWI和VFI方法（PWI+VFI）并量化合规性的生物标志物 和流程以提供有关斑块稳定性的关键生物力学信息。在报告中 研究，我们的小组表明，大动物和中风患者的斑块表征 可以实现。我们已经证明了PWI+VFI能够表征颈动脉 斑块基于其独特的刚度和流动。在这项研究中，我们旨在 颈动脉斑块的表征最终可靠地评估缺血性中风风险 基于斑块墙和流动生物标志物。因此，我们假设PWI可以显着 增强常规血管超声的诊断能力。组装的团队是 超声成像，生物力学，血管中的高度多学科的专业知识 放射学，病理学，神经病学，血管手术和生物统计学。遵循提议 研究，这种高度转化的技术可以很容易地将 准确地告知颈动脉斑块稳定性，从而随后进行及时治疗。