A three-dimensional biomodel of type A aortic dissection for endovascular interventions
A three-dimensional biomodel of type A aortic dissection for endovascular interventions
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DOI：
10.1007/s10047-021-01294-0
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发表时间：
2021-10-05
影响因子：
1.3
通讯作者：
Yamaguchi, Atsushi
中科院分区：
文献类型：
--
作者：
Arakawa, Mamoru;Sumikura, Hirohito;Yamaguchi, Atsushi
胸主动脉腔内修复术广泛用于治疗B型主动脉夹层。然而，目前还没有适合 A 型主动脉夹层的覆膜支架。设备开发的一个重大限制是缺乏 A 型主动脉夹层的实验模型。我们开发了一种用于血管内介入治疗的新型 A 型主动脉夹层三维生物模型。根据来自 A 型主动脉夹层患者的计算机断层扫描图像的医学数字成像和通信数据，使用激光立体光刻和随后的真空铸造创建了具有真腔、假腔和位于升主动脉入口撕裂的三维生物模型。该生物模型连接到脉动模拟电路。我们进行了四项测试：临床血流动力学的耐力测试、将线插入生物模型、快速起搏以及支架移植物放置的模拟。该生物模型成功模拟临床血流动力学；达到了目标血压和心输出量。导丝通过入口撕裂穿过真腔和假腔。压力和流量在快速起搏时下降，并在停止后恢复。该模拟生物模型检测到通过支架移植物放置减少了假腔流量并检测到残余泄漏。具有脉动模拟回路的 A 型主动脉夹层三维生物模型实现了目标临床血流动力学，证明了未来在模拟血管内手术期间使用的可行性，并评估了血流动力学的变化。
Thoracic endovascular aortic repair is widely used for type B aortic dissection. However, there is no favorable stent-graft for type A aortic dissection. A significant limitation for device development is the lack of an experimental model for type A aortic dissection. We developed a novel three-dimensional biomodel of type A aortic dissection for endovascular interventions. Based on Digital Imaging and Communication in Medicine data from the computed tomography image of a patient with a type A aortic dissection, a three-dimensional biomodel with a true lumen, a false lumen, and an entry tear located at the ascending aorta was created using laser stereolithography and subsequent vacuum casting. The biomodel was connected to a pulsatile mock circuit. We conducted four tests: an endurance test for clinical hemodynamics, wire insertion into the biomodel, rapid pacing, and simulation of stent-graft placement. The biomodel successfully simulated clinical hemodynamics; the target blood pressure and cardiac output were achieved. The guidewire crossed both true and false lumens via the entry tear. The pressure and flow dropped upon rapid pacing and recovered after it was stopped. This simulation biomodel detected decreased false luminal flow by stent-graft placement and detected residual leak. The three-dimensional biomodel of type A aortic dissection with a pulsatile mock circuit achieved target clinical hemodynamics, demonstrated feasibility for future use during the simulated endovascular procedure, and evaluated changes in the hemodynamics.