Biomechanical issues in endovascular device design.
Biomechanical issues in endovascular device design.
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DOI：
10.1583/08-2605.1
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发表时间：
2009-02
期刊：
影响因子：
--
通讯作者：
Moore JE Jr
中科院分区：
文献类型：
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作者：
Moore JE Jr
动脉系统的生物力学性质及其主要疾病状态为治疗策略提供了一系列挑战。血管内装置的设计目标主要集中在短期挑战上，如可部署性和立即恢复可靠的血流通道。由此产生的设计特点可能与长期的临床成功不一致。支架内再狭窄、内漏和装置结构完整性的丧失(如支架骨折)都是宿主血管生物力学环境和植入设计之间缺乏兼容性的表现。为了提高兼容性而调整设备设计的最初尝试，包括药物洗脱和生物可吸收支架，几乎没有开始探索如何及时调整植入设计，以将失败风险降至最低。生物力学建模有可能提供一个虚拟的血管环境，在其中可以测试新设计对长期组织反应的影响。这些模型将基于高质量、高分辨率的成像信息，以及从细胞到整个组织水平的机械生物学实验。然后，可以扩展这些模型以纳入生物降解机制，促进设计下一代设备，其设计(包括药物输送配置文件)会随着时间的推移而改变，以增强愈合。根据血管愈合信息(通过临床干预或自动化方法)启动设备设计或药物释放更改的可能性为真正个性化的动态设备设计优化提供了机会。
The biomechanical nature of the arterial system and its major disease states provides a series of challenges to treatment strategies. Endovascular device design objectives have mostly centered around short term challenges such as deployability and immediate restoration of reliable flow channels. The resulting design features may be at odds with long term clinical success. In-stent restenosis, endoleaks and loss of device structural integrity (e.g., strut fractures) are all manifestations of a lack of compatibility between the host vessel biomechanical environment and implant design. Initial attempts to adapt device designs for increased compatibility, including drug eluting and bioabsorbable stents, barely begin to explore the ways in which implant design can be modulated in time to minimize risk of failure. Biomechanical modeling has the potential to provide a virtual vascular environment in which new designs can be tested for their implications on long term tissue reaction. These models will be based on high quality, highly resolved imaging information, as well as mechanobiology experiments from the cellular to the whole tissue level. These models can then be extended to incorporate biodegradation mechanics, facilitating the design of the next generations of devices whose designs (including drug delivery profiles) change with time to enhance healing. The possibility of initiating changes in device design or drug release according to information on vascular healing (through clinical intervention or automated methods) provides the opportunity for truly individualized dynamic device design optimization.