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

使用先进的 MR 血流分析提高窦支架置入术治疗特发性颅内高压的耐用性

• 批准号: 10002598
• 负责人: Matthew Amans
• 金额: $ 55.45万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-20 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10002598
• 关键词: Acceleration; Accounting; Adoption; Affect; Aftercare; American; Anatomy; Anxiety; Auditory Perception; Biological; Blindness; Blood Vessels; Cerebrum; Clinic; Clinical; Communities; Community Hospitals; Comorbidity; Complication; Computer Simulation; Dangerousness; Data; Development; Devices; Disease; Distress; Elasticity; Environment; Essential Hypertension; Evaluation; Failure; Feedback; Feeling suicidal; Female of child bearing age; Functional disorder; Generations; Grant; Hardness; Headache; Hospitals; Hypertension; Image; Imaging Techniques; Impaired cognition; Implant; In Vitro; Incidence; Individual; Interruption; Intracranial Hemorrhages; Intracranial Hypertension; Intracranial Pressure; Lead; Life; Liquid substance; Manometry; Measurement; Measures; Mental disorders; Metals; Methods; Modeling; Obesity Epidemic; Odds Ratio; Operative Surgical Procedures; Overweight; Pain; Pathologic; Patients; Periodicity; Physicians; Prevalence; Procedures; Pseudotumor Cerebri; Pulsatile Tinnitus; Radial; Radiation; Recurrence; Regression Analysis; Relapse; Resolution; Risk; Sampling; Sinus; Societies; Source; Stenosis; Stents; Symptoms; Techniques; Veins; Venous; Venous Pressure level; Work; base; cohort; comorbid depression; design; disorder risk; experimental study; flexibility; hemodynamics; implantable device; improved; in vivo; insight; migration; novel therapeutics; pressure; prototype; sound; therapy development; tool; treatment optimization; treatment strategy; venous sinus; young woman

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.

项目摘要/摘要 特发性颅内高血压（IIH）是颅内压（ICP）的严重病理升高，可以 导致失明，认知能力下降，使人衰弱的头痛和令人痛苦的脉冲耳鸣（PT）。 iih最多 通常发生在育龄的超重女性中 该患者队列，患病率随着肥胖症流行的膨胀而继续增加。静脉窦 支架（VSS）是IIH的一种有希望的新兴疗法，其中操作员将支架植入大脑 使用血管内技术的静脉鼻窦。 VSS具有有利的功效，复发率和 并发症率，还有很大的改进空间。 VSS患者中IIH的复发通常是 由于边缘狭窄的发展，VSS近端。负责边缘狭窄的流动条件 发展是未知的。此外，并非所有患者在VSS之后的PT分辨率持久。 Pt是 通常归因于也受IIH影响的静脉流动异常，但 IIH中PT的返回也未知。在大多数颅内支架中对血液动力学的评估不是 由于其高金属含量，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，该研究将首先开发改进的MR测量方法的方法 静脉解释了湍流，开发了柔性壁的患者特异性流量模型，以说明 脑静脉窦的独特环境，MR方法用于测量这些速度场 模型以及计算流体动力学以询问无法轻易操纵的特征 体内或模型中。这些技术的进步将允许对血液动力学的强大描述， 包括压力和湍流，存在于治疗前和治疗后患者中。我们将 比较获得的血液动力学变量，几何变量和生物学变量与纵向变量 评估用VSS治疗的IIH患者，以确定每个变量的赔率根据修订要求 使用回归分析的手术和PT复发。这些数据将用于开发临床工具 原型旨在帮助医生确定每个患者的理想支架尺寸。