The Role of Multiple Re-Entry Tears in Type B Aortic Dissection Progression: A Longitudinal Study Using a Controlled Swine Model.
The Role of Multiple Re-Entry Tears in Type B Aortic Dissection Progression: A Longitudinal Study Using a Controlled Swine Model.
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DOI：
10.1177/15266028221111295
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发表时间：
2024-02
影响因子：
2.6
通讯作者：
Xu, Xiao Yun
中科院分区：
文献类型：
--
作者：
Armour, Chloe;Guo, Baolei;Saitta, Simone;Guo, Daqiao;Liu, Yifan;Fu, Weiguo;Dong, Zhihui;Xu, Xiao Yun
假腔（FL）扩张通常发生在B型主动脉夹层（TBAD）中，并与存在折返性撕裂相关。本纵向研究旨在使用对照猪模型，通过联合成像和计算建模评估主动脉血流动力学，阐明再入撕裂在TBAD进展中的作用。在先前的研究中创建了在左锁骨下动脉远端7 cm处具有主要入口撕裂的TBAD猪模型。在当前研究中，在该猪模型中进行了再干预，以诱导2处直径约为5 mm的额外再进入撕裂。在再次介入治疗前后的多次随访中进行计算机断层扫描（CT）和四维（4D）血流磁共振成像（MRI）扫描。通过CT扫描测量主动脉容积的变化，并根据4D流式MRI和计算流体动力学获取的动态数据（结合所有可用的体内数据进行模拟）评估血液动力学参数。形态学分析显示，在初始TBAD生长后，FL生长20%，在产生额外撕裂后稳定，最终FL体积减少6%。将再进入撕裂的数量从1增加到2导致血流重新分布，真腔（TL）血流的百分比从56%增加到78%;改变局部速度;降低撕裂周围的壁面剪切应力;并导致FL压力和2个管腔之间的压差降低。本研究结合了大量的体内成像数据和复杂的计算方法，表明额外的折返撕裂可通过TL和FL之间的血流再分布改变夹层血流动力学。这有助于降低FL压力，从而可能稳定主动脉生长并导致FL扩张逆转。这项工作提供了一个起点，为进一步研究使用开窗控制不良FL扩张。主动脉生长和假腔（FL）通畅与B型主动脉夹层（TBAD）患者的折返性撕裂相关。缺乏关于如何治疗折返性撕裂的指南，特别是关于FL扩张的控制和预防。通过对受控猪模型进行的联合成像和计算血流动力学研究，我们发现增加折返撕裂次数可降低FL压力和跨腔压差，从而可能稳定主动脉生长并导致FL减少。我们的研究结果提供了一个起点，进一步研究使用开窗控制不良FL扩张。
False lumen (FL) expansion often occurs in type B aortic dissection (TBAD) and has been associated with the presence of re-entry tears. This longitudinal study aims to elucidate the role of re-entry tears in the progression of TBAD using a controlled swine model, by assessing aortic hemodynamics through combined imaging and computational modeling. A TBAD swine model with a primary entry tear at 7 cm distal to the left subclavian artery was created in a previous study. In the current study, reintervention was carried out in this swine model to induce 2 additional re-entry tears of approximately 5 mm in diameter. Computed tomography (CT) and 4-dimensional (4D) flow magnetic resonance imaging (MRI) scans were taken at multiple follow-ups before and after reintervention. Changes in aortic volume were measured on CT scans, and hemodynamic parameters were evaluated based on dynamic data acquired with 4D-flow MRI and computational fluid dynamics simulations incorporating all available in vivo data. Morphological analysis showed FL growth of 20% following the initial TBAD—growth stabilized after the creation of additional tears and eventually FL volume reduced by 6%. Increasing the number of re-entry tears from 1 to 2 caused flow redistribution, with the percentage of true lumen (TL) flow increasing from 56% to 78%; altered local velocities; reduced wall shear stress surrounding the tears; and led to a reduction in FL pressure and pressure difference between the 2 lumina. This study combined extensive in vivo imaging data with sophisticated computational methods to show that additional re-entry tears can alter dissection hemodynamics through redistribution of flow between the TL and FL. This helps to reduce FL pressure, which could potentially stabilize aortic growth and lead to reversal of FL expansion. This work provides a starting point for further study into the use of fenestration in controlling undesirable FL expansion. Aortic growth and false lumen (FL) patency are associated with the presence of re-entry tears in type B aortic dissection (TBAD) patients. Guidelines on how to treat re-entry tears are lacking, especially with regards to the control and prevention of FL expansion. Through a combined imagining and computational hemodynamics study of a controlled swine model, we found that increasing the number of re-entry tears reduced FL pressure and cross lumen pressure difference, potentially stabilising aortic growth and leading to FL reduction. Our findings provide a starting point for further study into the use of fenestration in controlling undesirable FL expansion.
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