A Magnetic Resonance Imaging Based Computational Analysis of Plaque Morphology and Hemodynamics in Patients with High Grade Asymptomatic Carotid Artery Stenosis

基于磁共振成像的高度无症状颈动脉狭窄患者斑块形态和血流动力学的计算分析

• 批准号: 10677431
• 负责人: Drew Jackson Braet
• 金额: $ 7.63万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10677431
• 关键词: Accounting; Anatomy; Angiography; Arterial Fatty Streak; Biomechanics; Calibration; Carotid Arteries; Carotid Artery Plaques; Carotid Endarterectomy; Carotid Stenosis; Cephalic; Cerebrovascular Circulation; Cerebrovascular Disorders; Cerebrum; Cessation of life; Clinical; Compensation; Computer Analysis; Data; Diagnosis; Diagnostic Imaging; Internal Carotid Artery Stenosis; Intervention; Ischemic Stroke; Lesion; Liquid substance; Magnetic Resonance Imaging; Methods; Modeling; Morphology; Operative Surgical Procedures; Patient Selection; Patient imaging; Patients; Perfusion; Postoperative Period; Protocols documentation; Qualifying; Severities; Stenosis; Stress; Stroke; Testing; United States; Vascularization; Work; arterial spin labeling; biomarker identification; cohort; disability; efficacy evaluation; hemodynamics; high risk; indexing; patient subsets; pressure; repaired; shear stress; stroke patient; stroke risk; ultrasound

PROJECT SUMMARY/ABSTRACT Internal carotid artery (ICA) stenosis is a leading cause of stroke, long-term disability, and death. Current assessment of ICA stenosis is based on estimation of % stenosis via duplex ultrasound (DUS) or cross-sectional angiography. Landmark studies suggested that asymptomatic patients with stenotic lesions >60% should be considered for carotid endarterectomy (CEA), however intervention is often reserved to those with stenotic lesions >80% and/or vulnerable plaques. The % stenosis alone is a poor surrogate for plaque vulnerability and does not identify patients at high risk for stroke. Moreover, stenosis severity does not account for indices such as plaque burden, wall shear stress (WSS), pressure gradients, and cerebral flow compensation which are key to understand stroke risk. Optimal patient selection for carotid artery revascularization, particularly in asymptomatic patients, remains a significant clinical need. We have developed a workflow based on patient-specific CFD modeling informed by MRI data, and demonstrated that patients with similar degrees of stenosis (> 70% stenosis diagnosed using DUS and/or cross sectional angiography) have differences in pressure gradients and cerebral blood flow. These results suggest again that anatomic and flow data alone fail to identify markers for stroke risk and patients who would benefit from carotid revascularization. In this proposal, we will leverage MRI to characterize plaque composition and CFD modeling to assess hemodynamic loads on the plaque to thus provide a better assessment of vulnerability. We hypothesize that patients with similar degrees of asymptomatic high-grade (> 70% stenosis on DUS velocity criteria) extracranial ICA stenosis will have differences in plaque morphology, hemodynamics stresses on the plaque, and cerebral perfusion that are independent of their DUS velocity profiles and stenosis severity. To test this hypothesis, we will pursue the following Aims: 1) To determine plaque composition using T1/T2 MRI, hemodynamic loads on the plaque and cerebral flow using MRI-calibrated CFD workflows in a cohort of patients with asymptomatic high grade ICA stenosis who have similar velocity profiles on DUS. 2) To characterize the degree of variability in the above metrics, and therefore test the validity of our hypothesis. 3) In a subset of the patients who are chosen for CEA, we will investigate the differences in pre-operative and post-operative hemodynamic to assess the efficacy of the surgical repair.

项目总结/文摘