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.

中风是第五大死因，也是可预防残疾和疾病的主要原因 根据美国心脏协会的最新统计数据，美国住院人数 协会。每年，大约 795,000 人继续经历新的或反复的 中风。平均每 40 秒美国就有一人中风， 大约每 4 分钟就有 1 人死亡。死亡率高的部分原因是 CT、MRI 和超声波等最先进的方法目前无法提供信息 及时干预。识别具有高风险、无症状颈动脉斑块的患者，尽管 因此，它们的低狭窄仍然是预防中风的一个难以捉摸但必不可少的步骤。当前 临床实践中，颈动脉斑块破裂的风险评估是根据内膜的程度来评估的。 中膜厚度 (IMT) 和腔内狭窄，尽管事实上它们并不一定 与易损斑块或随后的破裂相关。目前的临床模式还不够 告知斑块稳定性。有关菌斑稳定性的可靠信息将确保及时 治疗，尤其是有中风风险的无症状或低度管腔狭窄患者 仍然严重漏诊。此类信息被证明很重要但临床上无法获得 在于斑块顺应性和相关的血流。脂质斑块（通常是 稳定性较差并与缺血性中风相关）已被证明具有明显的硬度 来自钙化斑块。据报道，中风患者的动脉僵硬度增加。这 因此，拟议研究的目标是通过优化颈动脉超声检查来放大颈动脉超声检查的作用 结合 PWI 和 VFI 方法（PWI+VFI）并量化依从性生物标志物 和流动，以便提供有关斑块稳定性的关键生物力学信息。在报道中 研究表明，大型动物和中风患者的斑块特征 可以实现。我们已经证明 PWI+VFI 能够表征颈动脉 基于其独特的硬度和流动性的斑块。在这项研究中，我们的目标是 颈动脉斑块的表征，以最终可靠地评估缺血性中风风险 基于斑块壁和流动生物标志物。因此，我们假设 PWI 可以显着 增强传统血管超声的诊断能力。组建的团队是 高度跨学科，涵盖超声成像、生物力学、血管学等方面的专业知识 放射学、病理学、神经病学、血管外科和生物统计学。遵循建议 研究表明，这种高度转化的技术可以很容易地集成到标准超声图中 准确告知颈动脉斑块稳定性，从而及时进行后续治疗。