Patient-Specific Simulations to Guide Coronary Bifurcation Stenting

方案总结/摘要 冠状动脉疾病是西方社会的主要死亡原因。支架植入率为70-90%， 美国每年进行130万例经皮冠状动脉介入治疗，其中20%涉及 分叉冠状动脉分叉仍然是介入治疗中最具挑战性的病变亚组之一， 心脏病学，手术成功率较低，长期不良心脏事件发生率增加， 在干预后6个月至1年的15-20%之间。尽管人们对这座建筑群很感兴趣 冠状动脉分叉病变的经皮治疗仍然是一个有争议的问题， 提出了技术战略。支架内的基本机械干扰似乎是 支架再狭窄的主要决定因素。没有两个分叉是相同的，也没有单一的治疗策略 它可以应用于每一个分叉。分叉干预中最重要的问题是选择 最适合具体分叉的策略。因此，我们打算首次调查 流体应力对支架再狭窄的作用。我们将使用经过验证的特定主题有限元 基于临床和实验数据的动脉分叉分析，以准确预测支架再狭窄。的 本提案的总体目标是使用个性化的方法来确定最佳分叉 支架植入技术。我们的中心假设是，特定于主题的模拟 分叉支架术优化了局部生物力学环境并减少了支架再狭窄。我们的建议 汇集了流体和固体力学方面的广泛专业知识、基础设施和初步工作， 计算机模拟和血管生物学。这些发现将建立临床相关的假设， 将作为我们长期目标的基础;一项大型随机对照试验， 患者特定分叉支架植入策略的结局。拟议的研究是一个例子， 具有术前规划的精准医学可以帮助优化分叉支架植入术， 成果。患者特定的计算支架植入模拟可能会改变冠状动脉疾病的管理模式 分叉干预，并提供了一个新的维度，如何改善支架植入术和后扩张 技术.

PROTOCOL SUMMARY/ABSTRACT Coronary artery disease is the leading cause of death in Western society. Stents are implanted in 70-90% of the 1.3 million percutaneous coronary interventions performed annually in the USA, of which 20% involve bifurcations. Coronary bifurcations remain one of the most challenging lesion subsets in interventional cardiology, with a lower procedural success rate and increased rates of long-term adverse cardiac events, ranging between 15-20% at six months to one year post-intervention. Despite the great interest in this complex lesion subset, percutaneous treatment of coronary bifurcations is still a controversial subject and multiple technical strategies have been proposed. Fundamental mechanical disturbances within the stent appear to be major determinants of stent restenosis. No two bifurcations are identical, and no single treatment strategy exists that can be applied to every bifurcation. The most important issue in bifurcation interventions is selecting the most appropriate strategy for a specific bifurcation. Accordingly, we intend to investigate for the first time in human the role of fluid stresses on stent restenosis. We will use a validated subject-specific finite element analysis of arterial bifurcations rooted in clinical and experimental data to faithfully predict stent restenosis. The overall objective of this proposal is to use an individualized approach to identify the optimal bifurcation stenting technique for a specific bifurcation. Our central hypothesis is that subject-specific simulations of bifurcation stenting optimize the local biomechanical environment and reduces stent restenosis. Our proposal brings together extensive expertise, infrastructure and preliminary work in fluid and solid mechanics, computational simulations and vascular biology. These findings will establish clinically-relevant hypotheses that will serve as basis for our long term goal; a large, randomized controlled trial to show improved clinical outcomes with patient-specific bifurcation stenting strategies. The proposed research is an example of how precision medicine with pre-procedural planning can help optimize bifurcation stenting and improve clinical outcomes. Patient-specific computational stenting simulations may shift the management paradigm of coronary bifurcation interventions and provide a new dimension on how to improve the stenting and post-dilatation techniques.