血流模式改变与管壁重构对胸主动脉夹层TEVAR术后假腔血栓化的调控机理研究

假腔血栓化是胸主动脉夹层（TAD）腔内修复（TEVAR）术后的重要病理改变，研究其发生机制对改善TAD的预后有重要意义。TEVAR术后血流重新分布，真、假两腔重新塑形，但血流模式改变与管壁重构对假腔血栓化的调控机理尚不清楚。我们前期基于4D flow MRI对TAD血流的量化分析发现假腔内流速与血栓化程度密切相关；TEVAR术后管腔和内膜片通过自身结构改变以适应血流再分布的新状态。据此我们推测TEVAR术后真、假腔内血流模式改变可能进一步影响管壁的组织重构，二者相互作用共同调控假腔血栓化过程。因此，我们拟通过建立猪的TEVAR模型，利用CT和4D flow MRI影像手段分析血栓化进程和血流分布特征；利用动物模型标本观察管壁和内膜片的组织病理学进展与炎症浸润水平。从血流和管壁的“时空”发展的新视角探讨二者对TEVAR术后假腔血栓化的调控作用，为提高TAD患者的预后提供理论基础。

The false lumen thrombus formation is recognized as the key factor in the pathophysiologic mechanisms of thoracic aortic dissection (TAD) following thoracic endovascular aortic repair (TEVAR). To identify novel the potential mechanisms will be greatly beneficial to TEVAR patients. The blood flow redistributed and recirculated in the false lumen in the acute phase post-TEVAR, resulting in the reconstruction of the aortic wall and flap over time. However, it is still unclear the potential mechanisms of the blood flow patterns and aortic wall remodelling impacting on the thrombus formation. Our previous study based on 4D flow MRI demonstrated that flow velocity in the false lumen is associated with the thrombus formation, while the aortic wall and flap adjust to the new blood flow patterns through changes of their microstructures. Combined with the related studies, we propose the hypothesis that the blood flow patterns in both true and false lumens might play an important role in the aortic wall remodelling, and impacting on the false lumen thrombosis. Therefore, by establishing a TEVAR model in swine, we aim (1) to observe the thrombus formation in false lumen post-TEVAR and the features of blood flow patterns by CT and 4D flow MRI imaging; (2) To investigate the pathophysiologic changes in aortic wall and flap with the purpose of studying the microenvironment factors and inflammation. Taken together, this study would provide a novel role in understanding the false lumen thrombus formation post-TEVAR from the spatial and temporal perspective of the blood flow and aortic wall, which would benefit to patients with TAD.