Improved durability of sinus stenting for idiopathic intracranial hypertension using advanced MR flow analysis

项目总结/摘要 特发性颅内高压（IIH）是一种严重的颅内压（ICP）病理性升高， 导致失明、认知能力下降、使人衰弱的头痛和令人痛苦的脉动性耳鸣（PT）。IIH最 通常发生在超重的育龄妇女中，虽然它的发病率为10万分之20， 在该患者队列中，患病率随着肥胖流行病的扩大而继续增加。静脉窦 支架植入术（VSS）是一种治疗IIH的有前途的新兴疗法， 静脉窦使用血管内技术。虽然VSS具有良好的疗效，复发率， 尽管并发症发生率很高，但仍有很大的改进空间。VSS患者IIH的复发通常是 由于VSS近端边缘狭窄的发展。导致边缘狭窄的血流条件 发展未知。此外，并非所有患者在VSS后PT均持久消退。PT是 通常归因于静脉中的血流异常，这些异常也受到IIH的影响，但IIH的具体原因是 在IIH中PT的返回也是未知的。大多数颅内支架内的血流动力学评价 由于它们的高金属含量，可以通过传统的成像技术。在这个项目中，我们将 进行系统的研究，将首先制定改进的方法，磁共振测量的压力， 静脉占湍流，开发灵活的壁患者特定的流动模型，占 脑静脉窦的独特环境，MR方法测量这些速度场， 模型，以及计算流体动力学，以询问无法轻松操纵的功能， 体内或模型中。这些技术的进步将允许对血流动力学进行稳健的描述， 包括治疗前和治疗后患者中存在的压力和湍流。我们将 将获得的血流动力学变量、几何变量和生物变量与纵向 评价接受VSS治疗的IIH患者，以确定每个变量对翻修要求的比值比 手术和PT复发之间的关系。这些数据将用于开发临床工具 原型，旨在帮助医生确定每例患者的理想支架尺寸。

PROJECT SUMMARY/ABSTRACT Idiopathic intracranial hypertension (IIH) is a serious pathologic elevation of intracranial pressure (ICP) that can lead to blindness, cognitive decline, debilitating headaches, and distressing pulsatile tinnitus (PT). IIH most commonly occurs in overweight women of childbearing age, and while it has an incidence of 20 in 100,000 in this patient cohort, the prevalence continues to increase with expansion of the obesity epidemic. Venous sinus stenting (VSS) is a promising emerging therapy for IIH in which operators implant a stent within the cerebral venous sinuses using endovascular technique. While VSS has favorable efficacy, relapse rates, and complication rates, there remains significant room for improvement. Relapse of IIH in VSS patients is typically due to development of edge-stenosis proximal to the VSS. The flow conditions responsible for edge-stenosis development are unknown. In addition, not all patients have durable resolution of their PT after VSS. PT is typically attributed to flow abnormalities in the veins that are also affected by IIH, but the specific cause of return of PT in IIH is also unknown. Evaluation of the hemodynamics within most intracranial stents is not possible through conventional imaging techniques due to their high-metal content. In this project we will conduct a systematic study that will first develop improved methods for MR measurement of pressure in the veins accounting for turbulent flow, developing flexible-walled patient-specific flow models that account for the unique environment of the cerebral venous sinuses, MR methods for measuring the velocity field in these models, as well as Computational Fluid Dynamics to interrogate features that cannot be easily manipulated in vivo or in the models. Advances in these techniques will allow for robust description of the hemodynamics, including pressure and turbulence, that is present in the pre-treatment and post-treatment patient. We will compare the obtained hemodynamic variables, geometric variables, and biologic variables to longitudinal evaluation of IIH patients treated with VSS to identify odds ratios of each variable on requirement of revision surgery and PT recurrence using regression analyses. This data will be used to develop a clinical tool prototype that is intended to assist physicians in determining the ideal stent size for each patient.