Computer assisted coronary artery stent interventions

计算机辅助冠状动脉支架介入治疗

• 批准号: 9589254
• 负责人: Hiram Bezerra
• 金额: $ 74.35万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9589254
• 关键词: Acute; Address; Area; Arteries; Atherectomy; Balloon Angioplasty; Balloon Dilatation; Biomechanics; Caliber; Clinical; Computer Assisted; Computer Simulation; Computer software; Coronary Stenosis; Coronary artery; Data; Data Set; Devices; Dissection; Distal; Elements; Evaluation; Event; Focus Groups; Fracture; Future; Guidelines; Image; Image Analysis; Intervention; Investigation; Lead; Length; Lesion; Licensure; Light; Measurement; Methodology; Methods; Microdissection; Modeling; Modification; Optical Coherence Tomography; Outcome; Predictive Value of Tests; Process; Quantitative Evaluations; Research; Resolution; Roentgen Rays; Role; Rupture; Stents; Stress; Techniques; Technology; Testing; Thick; Time; Tissues; Work; X-Ray Computed Tomography; aging population; biomechanical model; calcification; clinical imaging; clinical practice; coronary artery calcification; experimental study; imaging modality; improved; insight; metallicity; microscopic imaging; predictive modeling; pressure; quantitative imaging; success; treatment choice; treatment guidelines; treatment optimization; treatment planning; treatment strategy

Computer assisted coronary artery stent interventions Summary When treating highly calcified coronary artery lesions with stents, interventional cardiologists, with limited in- formation, make stressful treatment decisions, which can lead to inadequate stent deployment and poor out- comes, or even rare calamitous events. When calcification is present, a cardiologist must choose to use a normal sized angioplasty balloon; a larger angioplasty balloon with increasingly high, prolonged pressures to fracture the calcification; a scoring or cutting balloon; any one of a number of atherectomy devices; and/or stent post-dilation balloon pressures up to 30 atm. The cardiologist must choose stent diameter and length, taking into account distal artery size, vessel taper, and extent (arc length and thickness) of calcification. Some potential negative consequences are that a stent can under deploy and/or have malapposed struts; a balloon can rupture; a vessel can dissect; or an atherectomy device can perforate the wall. Intravascular optical coher- ence tomography (IVOCT) evaluations of stent deployment show that large eccentric calcifications often lead to under deployment with malapposition of struts and small vessel dissections. To address these challenges, specific aims are: 1) Develop methods for imaging/quantifying calcifications in pre-stent images. 2) Perform ex vivo experiments to obtain detailed biomechanical data and demonstrate key issues in stent deployment. 3) Develop well-validated, lesion specific FEM models. 4) Use in silico experiments and physical measure- ments to elucidate issues in stent deployment and establish guidelines for treatment. With success, the project will lead to future decision-support software for live-time treatment planning from IVOCT or other imaging mo- dalities. The project team will build on expertise in interventions, quantitative image analysis of IVOCT, and fi- nite element modeling.

计算机辅助冠状动脉支架植入术 总结 当用支架治疗高度钙化的冠状动脉病变时，介入心脏病专家， 形成，作出紧张的治疗决定，这可能导致支架展开不足和不良的外- 甚至是罕见的灾难性事件。当存在钙化时，心脏病专家必须选择使用 正常尺寸的血管成形术球囊;更大的血管成形术球囊，压力越来越高， 使钙化破裂;刻痕或切割球囊;多种斑块切除装置中的任一种;和/或 支架后扩张球囊压力高达30 atm。心脏病专家必须选择支架直径和长度， 考虑远端动脉尺寸、血管锥度和钙化程度（弧长和厚度）。一些 潜在的负面后果是支架可能展开不足和/或支柱贴壁不良;球囊 可能破裂;血管可能分离;或者斑块切除术装置可能破坏壁。血管内光学相干- 血管造影（IVOCT）对支架展开的评价显示，大的偏心性钙化常常导致 展开不足，支柱贴壁不良和小血管夹层。为了应付这些挑战， 具体目标是：1）开发支架植入前图像中钙化成像/量化的方法。2)执行前 体内实验，以获得详细的生物力学数据，并证明在支架部署的关键问题。 3)开发经过充分验证的病变特异性FEM模型。4)使用计算机实验和物理测量- 阐明支架展开中的问题并建立治疗指南。随着项目的成功， 将导致未来的决策支持软件，用于IVOCT或其他成像技术的实时治疗计划， dalities。该项目团队将建立在干预、IVOCT定量图像分析和FI方面的专业知识基础上， nite元素建模