EPSRC Centre for Future PCI Planning

经皮冠状动脉介入治疗（PCI）是一种常见的临床手术，用于治疗阻塞性冠状动脉疾病，这是导致死亡的主要原因之一。绝大多数患者将接受药物洗脱支架装置，作为支撑支架并输送药物以对抗再狭窄。虽然这项技术是真正革命性的，但全世界每年仍有数十万患者需要进行侵入性重复手术，这对社会造成了巨大的经济负担，并对医疗资源造成了越来越大的压力。关键问题是，目前还无法定量预测特定干预措施的直接效果，以及患者是否/何时会出现长期再狭窄。因此，迫切需要能够根据患者具体情况优化程序的工具，以改善患者的治疗效果并减轻医疗保健提供者的资源负担。优化该程序的关键是评估个体患者的疾病水平。医学成像技术的进步使得观察阻塞的程度成为可能，更重要的是，观察潜在斑块的组成，这可能为临床医生提供丰富的信息来指导和计划PCI。然而，目前的决定取决于操作者的经验，对于如何优化特定患者的PCI，特别是在复杂病例中，没有明确的指导方针。近年来，我们已经看到了PCI计算模型的重大发展，这有可能为未来的PCI策略提供信息。然而，它们受到限制，并且在将其常规整合到临床之前，需要在方法上取得重大进展。这些主要涉及到提高模型的真实感和准确性，提高其鲁棒性，预测能力和计算速度。最后一点是至关重要的，当前计算模型过高的运行时间严重阻碍了及时的决策支持和对临床的真正影响。EPSRC未来PCI计划中心将通过开发一种计算决策支持工具来帮助临床医生进行PCI计划来解决这些挑战。流体结构相互作用、病变准备、药物输送、生长和重塑的数学模型的进步，与统计推断、仿真、不确定性量化和优化相结合，将使我们能够创建能够回答关键临床问题的计算工具，例如：1)给定患者的动脉在设备部署后立即会是什么样子？2)在支架放置前如何对斑块进行修饰？应该使用哪些专业工具进行修饰？3)支架的长度和直径应该是多少，球囊部署充气压力应该是多少？4)支架的最佳放置位置是什么？5)在复杂分叉病变的情况下，可能部署多个支架和球囊，最佳技术是什么？6)动脉可能再狭窄到什么程度，需要多长时间，如何优化PCI策略以避免这种情况？7)我们能否仅根据术前成像（如计算机断层扫描）有效地规划PCI ？与世界领先的国际中心，以及一系列领先的成像和医疗设备公司合作，EPSRC未来PCI计划中心将开发新颖而强大的数学和统计方法，由大型临床数据集支持，创建新颖，快速和准确的工具，这将有助于实现我们在诊所内整合PCI计划计算工具的愿景。

Percutaneous Coronary Intervention (PCI) is a common clinical procedure used to treat obstructive coronary artery disease, one of the leading causes of death. The overwhelming majority of patients will receive drug-eluting stent devices that act as a supporting scaffold and deliver drugs to counteract renarrowing. While this technology has been truly revolutionary, hundreds of thousands of patients worldwide annually still require an invasive repeat procedure, representing a huge economic burden on society and increasing pressure on health care resources. The key issue is that it is currently not feasible to quantitatively predict the immediate effect of a specific intervention and if/when a patient will suffer from renarrowing in the longer-term. Tools that enable optimisation of the procedure on a patient-specific basis are therefore urgently needed to improve patient outcomes and alleviate the resource burden on healthcare providers.Critical to optimising the procedure is assessment of the individual patient's level of disease. Advances in medical imaging technology now make it possible to visualise the degree of obstruction and, crucially, the composition of the underlying plaque, potentially providing clinicians with a wealth of information to inform and plan PCI. However, decisions are presently left to operator experience and there are no definitive guidelines for how to optimise PCI for a given patient, particularly in complex cases.In recent years, we have seen significant developments in computational models of PCI, that have the potential to inform PCI strategy in the future. However, they suffer from limitations and significant methodological advances are required before they can be routinely integrated within the clinic. These primarily relate to increasing the realism and accuracy of the models, improving their robustness, predictive power and speed of computation. This last point is critical, with the exorbitant run times of current computational models significantly hampering timely decision support and genuine impact in the clinic.The EPSRC Centre for Future PCI Planning will address these challenges by developing a computational decision support tool to assist clinicians with PCI planning. Advances in mathematical modelling of fluid-structure interaction, lesion preparation, drug delivery and growth & remodelling, allied to statistical inference, emulation, uncertainty quantification and optimisation will enable us to create computational tools able to answer key clinical questions like:1) What will a given patient's artery look like immediately after device deployment?2) How should the plaque be modified prior to stent deployment, and what specialist tools should be used to do this?3) What length and diameter of stent should be used, and what should be the balloon deployment inflation pressure?4) What is the optimal placement of the stent?5) In the case of complex bifurcation lesions, where potentially multiple stents and balloons are deployed, what is the optimal technique?6) To what extent is the artery likely to renarrow, over what time course, and how can the PCI strategy be optimised to avoid this?7) Can we effectively plan PCI solely on pre-procedural imaging such as Computed Tomography?Working together with world-leading International Centres, and a range of leading imaging and medical device companies, the EPSRC Centre for Future PCI Planning will develop novel and robust mathematical and statistical methodologies, supported by large clinical data sets, to create the novel, fast and accurate tools that will help realise our vision of integrating computational tools for PCI planning within the clinic.