3D Multi-Functional Catheter-Based Imaging of Coronary Lesion Composition, Structure, and Hemodynamics in Intermediate Stenoses

项目总结/摘要 美国每年有超过100万患者接受心导管插入术，其中超过20万患者 有稳定的冠状动脉疾病大约10%的病情稳定患者会出现重大不良反应， 在给定的两年内发生。目前基于独立指标的成像方法在很大程度上未能 预测不良事件，因此目前还没有技术能够确定哪些患者可能发生不良事件 发生不良事件，如心肌梗死（MI）。根据以下因素做出治疗决定的能力 全面、同步测量完整的冠状动脉环境，包括生物力学和 血液动力学-而不是独立的指标，可以改善结果和降低成本的风险患者。 该项目建议开发一种非常小的前视超声导管，能够同时 询问全面的3D冠状动脉环境，以指导心导管实验室的决策。 具体而言，CoSHIS导管（中度狭窄的成分、结构和血流动力学）将 同时以实时3D方式量化冠状动脉环境（包括斑块力学和血流）， 目前的成像方法寻求识别斑块破裂的独立指标。为了实现这一多- 功能量化指导治疗决策，需要技术开发，以确保准确 性能在一个非常小的形式因素。通过利用超声成像技术的最新进展， 设计、数据重建、高帧速率图像形成和设计用于最小化流量的内部流量导管 干扰，该项目将开发冠状动脉力学环境4D标测的核心技术 这项在心导管实验室进行成像引导介入的技术将联合超声方面的专业知识， 成像和技术开发，基于成像的计算建模，冠状动脉疾病的动物模型， 和介入心脏病学，并将根据以下三个目标发展： 1.用于病变形态3D血管内超声（US）成像的前视系统的开发， 血液动力学和斑块组成。 2.使用包括计算机断层扫描在内的现有技术验证新型超声测量技术 (CT)、基于血管造影术的计算流体动力学（CFD）和虚拟组织学血管内超声。 3.在中度狭窄动物模型中同时进行基于US的测量的评价，并使用 建立技术。

PROJECT SUMMARY / ABSTRACT More than 1 million patients in the U.S. undergo cardiac catheterization each year, and more than 200k of these patients have stable coronary artery disease. Approximately 10% of patients with stable disease will experience a major adverse event within a given two year period. Current imaging approaches based on independent indicators have largely failed to predict adverse events, thus there are currently no techniques capable of determining which patients are likely to experience adverse events such as myocardial infarction (MI). The ability to make treatment decisions based on comprehensive, simultaneous measurements of the complete coronary environment—including biomechanics and hemodynamics—rather than independent indicators could improve outcomes and reduce costs in at-risk patients. This project proposes to develop a very small, forward-viewing ultrasound catheter capable of simultaneously interrogating the comprehensive 3D coronary environment in order to guide decisions in the cardiac catheterization lab. Specifically, the CoSHIS catheter (Composition, Structure, and Hemodynamics in Intermediate Stenoses) will simultaneously quantify the coronary environment (including plaque mechanics and blood flow) in real-time 3D, unlike current imaging approaches that seek to identify independent indicators of plaque rupture. In order to enable this multi- functional quantification to guide treatment decisions, technological development is needed to ensure accurate performance in a very small form factor. By leveraging recent advances in ultrasound imaging technology including array design, data reconstruction, high frame rate image formation, and internal flow catheters designed to minimize flow disturbance, this project will develop the core technology on for 4D mapping of the coronary mechanical enviornment This technology for imaging-guided intervention in the cardiac catheterization lab will unite expertise in ultrasound imaging and technology development, imaging-based computational modeling, animal models of coronary artery disease, and interventional cardiology, and will be developed according to the following three Aims: 1. Development of a forward-viewing system for 3D intravascular ultrasound (US) imaging of lesion morphology, hemodynamics, and plaque composition. 2. Validation of novel ultrasound measurement technology with established techniques including computed tomography (CT), computational fluid dynamics (CFD) based on angiography, and virtual histology intravascular ultrasound. 3. Evaluation of simultaneous US-based measurement in animal models of intermediate stenoses with validation using established techniques.