Computational and Biological Approach to Flow Diversion

分流的计算和生物学方法

• 批准号: 8335380
• 负责人: Ramanathan Kadirvel
• 金额: $ 52.61万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-20 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8335380
• 关键词: Aftercare; Aneurysm; Animal Model; Anticoagulants; Arteries; Binding Proteins; Biocompatible Materials; Biological; Biological Process; Blood Vessels; Brain Aneurysms; Capsid Proteins; Case Series; Cell Proliferation; Chronic; Communities; Computer Simulation; Coupled; Coupling; Development; Devices; Dose; Endothelial Cells; Evaluation; Frequencies; Future; General Population; Goals; Healed; Histologic; Image; Implant; Individual; Interdisciplinary Study; Intracranial Aneurysm; Knowledge; Lead; Liquid substance; Marketing; Measurement; Metric; Microarray Analysis; Modeling; Modification; Molecular; Morphology; Neck; Oryctolagus cuniculus; Outcome; Parents; Patient Care; Patients; Perforating Artery; Pharmaceutical Preparations; Platinum; Population; Recurrence; Research; Research Personnel; Research Proposals; Retreatment; Risk; Role; Rupture; Ruptured Aneurysm; Safety; Series; Speed; Spontaneous Rupture; Stem cells; Stroke; Structure; System; Techniques; Therapeutic Embolization; Thrombosis; Thrombus; Time; Tissues; Translational Research; Work; brain surgery; cell motility; clinical application; clinically relevant; cost; density; healing; hemodynamics; implantation; improved; in vivo; minimally invasive; novel strategies; preclinical evaluation; primary outcome; programs; research study; response; tool; treatment planning; treatment response; virtual

DESCRIPTION (provided by applicant): The long term objective of this research program is to improve the care of patients harboring unruptured brain aneurysms. These aneurysms, present in approximately 2% of the population, may undergo spontaneous rupture with devastating consequences. Recent advances in minimally invasive treatments have allowed many patients to avoid open brain surgery. Unfortunately, these newer treatments often result in imperfect closure of the aneurysm, requiring additional treatments. A recently developed technique, called intraluminal flow diversion, has shown remarkable promise in treating even large or giant aneurysms, which are not well treated with any other technique. Notwithstanding promising results from small series of treated patients, many important questions about these new devices remain unanswered. First, practitioners have no concrete information on how to choose device size or number of devices in order to achieve aneurysm cure; addition of "unnecessary" devices increases risk to patients and thus knowledge about the "ideal" device for a given patient would be an important step forward. Second, the actual reasons behind why these flow diverters result in aneurysm cure remain unknown; advancing our knowledge of how they actually function would not only help individual patients but also speed development of improved devices. Third, a number of patients treated with these devices have suffered unexpected and usually fatal rupture of the aneurysm after treatment, which has convinced many practitioners either to avoid the use of flow diverters altogether or to use, at the same time, coil treatment in the aneurysm; adding the coil therapy increases both cost and risk, and thus understanding the reasons behind these rare but devastating ruptures would improve patient care. Finally, all patients treated with these devices require long term treatment with blood thinning medications; improvements in the device to avoid this need would decrease overall risk. The experiments outlined in this proposal include the latest advances in computer-based simulations of aneurysm flows, both before and after treatment, coupled with use of a widely-studied animal model. Study of these experimental systems will allow us to answer each of the important questions listed above, with the long term objective of safely and permanently curing brain aneurysms.

描述（由申请人提供）：该研究计划的长期目标是改善对未破裂脑动脉瘤患者的护理。这些动脉瘤约占人口的 2%，可能会自发破裂，造成毁灭性后果。微创治疗的最新进展使许多患者避免了开颅手术。不幸的是，这些新的治疗方法通常会导致动脉瘤闭合不完美，需要额外的治疗。最近开发的一种称为腔内血流改道的技术，在治疗任何其他技术都无法很好地治疗的大动脉瘤或巨大动脉瘤方面显示出了显着的前景。尽管小系列治疗患者取得了有希望的结果，但有关这些新设备的许多重要问题仍未得到解答。首先，从业者没有关于如何选择装置尺寸或装置数量以实现动脉瘤治愈的具体信息；添加“不必要的”设备会增加患者的风险，因此了解特定患者的“理想”设备将是向前迈出的重要一步。其次，这些分流器导致动脉瘤治愈的真正原因仍然未知。提高我们对它们实际功能的了解不仅可以帮助个别患者，还可以加快改进设备的开发。第三，许多使用这些装置治疗的患者在治疗后出现了意想不到的、通常是致命的动脉瘤破裂，这使得许多医生要么完全避免使用分流器，要么同时在动脉瘤中使用弹簧圈治疗；增加线圈疗法会增加成本和风险，因此了解这些罕见但具有破坏性的破裂背后的原因将改善患者护理。最后，所有使用这些设备治疗的患者都需要使用血液稀释药物进行长期治疗；为避免这种需要而改进设备将降低总体风险。该提案中概述的实验包括治疗前后动脉瘤血流计算机模拟的最新进展，以及广泛研究的动物模型的使用。对这些实验系统的研究将使我们能够回答上面列出的每个重要问题，并实现安全、永久治愈脑动脉瘤的长期目标。