EPSRC Centre for Future PCI Planning

EPSRC 未来 PCI 规划中心

• 批准号: EP/Z531182/1
• 负责人: Sean McGinty
• 金额: $ 162.53万
• 依托单位: University of Glasgow
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2024
• 资助国家: 英国
• 起止时间: 2024 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=EP%2FZ531182%2F1
• 关键词: EPSRC; Centre; Future; PCI; Planning

Percutaneous Coronary Intervention (PCI) is a common clinical procedure used to treat obstructive coronary artery disease, one of the leading causes of death. The overwhelming majority of patients will receive drug-eluting stent devices that act as a supporting scaffold and deliver drugs to counteract renarrowing. While this technology has been truly revolutionary, hundreds of thousands of patients worldwide annually still require an invasive repeat procedure, representing a huge economic burden on society and increasing pressure on health care resources. The key issue is that it is currently not feasible to quantitatively predict the immediate effect of a specific intervention and if/when a patient will suffer from renarrowing in the longer-term. Tools that enable optimisation of the procedure on a patient-specific basis are therefore urgently needed to improve patient outcomes and alleviate the resource burden on healthcare providers.Critical to optimising the procedure is assessment of the individual patient's level of disease. Advances in medical imaging technology now make it possible to visualise the degree of obstruction and, crucially, the composition of the underlying plaque, potentially providing clinicians with a wealth of information to inform and plan PCI. However, decisions are presently left to operator experience and there are no definitive guidelines for how to optimise PCI for a given patient, particularly in complex cases.In recent years, we have seen significant developments in computational models of PCI, that have the potential to inform PCI strategy in the future. However, they suffer from limitations and significant methodological advances are required before they can be routinely integrated within the clinic. These primarily relate to increasing the realism and accuracy of the models, improving their robustness, predictive power and speed of computation. This last point is critical, with the exorbitant run times of current computational models significantly hampering timely decision support and genuine impact in the clinic.The EPSRC Centre for Future PCI Planning will address these challenges by developing a computational decision support tool to assist clinicians with PCI planning. Advances in mathematical modelling of fluid-structure interaction, lesion preparation, drug delivery and growth & remodelling, allied to statistical inference, emulation, uncertainty quantification and optimisation will enable us to create computational tools able to answer key clinical questions like:1) What will a given patient's artery look like immediately after device deployment?2) How should the plaque be modified prior to stent deployment, and what specialist tools should be used to do this?3) What length and diameter of stent should be used, and what should be the balloon deployment inflation pressure?4) What is the optimal placement of the stent?5) In the case of complex bifurcation lesions, where potentially multiple stents and balloons are deployed, what is the optimal technique?6) To what extent is the artery likely to renarrow, over what time course, and how can the PCI strategy be optimised to avoid this?7) Can we effectively plan PCI solely on pre-procedural imaging such as Computed Tomography?Working together with world-leading International Centres, and a range of leading imaging and medical device companies, the EPSRC Centre for Future PCI Planning will develop novel and robust mathematical and statistical methodologies, supported by large clinical data sets, to create the novel, fast and accurate tools that will help realise our vision of integrating computational tools for PCI planning within the clinic.

经皮冠状动脉介入治疗（PCI）是一种常见的临床手术，用于治疗阻塞性冠状动脉疾病，这是导致死亡的主要原因之一。绝大多数患者将接受药物洗脱支架装置，作为一个支持支架和提供药物，以抵消再狭窄。虽然这项技术确实具有革命性，但全球每年仍有数十万患者需要重复侵入性手术，这给社会带来了巨大的经济负担，并增加了医疗资源的压力。关键问题是，目前无法定量预测特定干预措施的即时效果，以及患者是否/何时会在较长时间内遭受再狭窄。因此，迫切需要能够根据患者的具体情况优化手术的工具，以改善患者的治疗效果，减轻医疗保健提供者的资源负担。优化手术的关键是评估个体患者的疾病水平。医学成像技术的进步现在可以可视化阻塞程度，关键是底层斑块的组成，可能为临床医生提供丰富的信息来告知和计划PCI。然而，决定目前留给操作员的经验，并没有明确的指导方针，如何优化PCI为特定的病人，特别是在复杂的cases.In近年来，我们已经看到了显着的发展，在计算模型的PCI，有可能告知PCI战略在未来。然而，他们遭受的限制和显着的方法进步之前，他们可以在诊所内进行常规整合。这些主要涉及增加模型的真实性和准确性，提高其鲁棒性，预测能力和计算速度。最后一点至关重要，当前计算模型的运行时间过长，严重阻碍了及时的决策支持和对临床的真正影响。EPSRC未来PCI规划中心将通过开发计算决策支持工具来解决这些挑战，以协助临床医生进行PCI规划。流体-结构相互作用、病变准备、药物输送和生长与重塑的数学建模的进展，与统计推断、仿真、不确定性量化和优化相结合，将使我们能够创建能够回答关键临床问题的计算工具，例如：1）给定患者的动脉在设备部署后立即会是什么样子？2)在支架展开前应如何修饰斑块，应使用哪些专业工具来进行修饰？3)应使用什么长度和直径的支架，球囊展开充盈压力应是多少？4)支架的最佳放置位置是什么？5)在复杂分叉病变的情况下，可能会展开多枚支架和球囊，最佳技术是什么？6)在什么程度上动脉可能会再狭窄，在什么时间过程中，如何优化PCI策略以避免这种情况？7)我们能否仅在术前成像（如计算机断层扫描）上有效地计划PCI？EPSRC未来PCI计划中心与世界领先的国际中心以及一系列领先的成像和医疗设备公司合作，将开发新颖而强大的数学和统计方法，并得到大型临床数据集的支持，以创建新颖，快速和准确的工具，这将有助于实现我们在临床中集成PCI计划计算工具的愿景。