Patient-Specific Simulations to Guide Coronary Bifurcation Stenting

协议摘要/摘要 在西方社会，冠状动脉疾病是主要的死亡原因。70%-90%的患者植入了支架 美国每年进行的130万次经皮冠状动脉介入治疗，其中20%涉及 分叉。冠状动脉分叉仍然是介入治疗中最具挑战性的病变亚群之一 心脏科，手术成功率较低，长期不良心脏事件发生率增加， 在干预后6个月至一年时为15%-20%。尽管人们对这个建筑群非常感兴趣 病变亚组，经皮冠状动脉分叉的治疗仍然是一个有争议的主题和多重 已经提出了技术策略。支架内的基本机械干扰似乎是 支架再狭窄的主要决定因素。没有两个分支是完全相同的，也没有单一的治疗策略 存在可以应用于每一个分叉的。分叉干预中最重要的问题是选择 对于特定的分支来说，最合适的策略。因此，我们打算在#年首次进行调查。 人体体液应力在支架再狭窄中的作用。我们将使用经过验证的特定于主题的有限元 分析源于临床和实验数据的动脉分叉以准确预测支架再狭窄。这个 该方案的总体目标是使用个性化的方法来确定最佳分叉 针对特定分叉的支架技术。我们的中心假设是，特定于对象的模拟 分叉支架可优化局部生物力学环境，减少支架再狭窄。我们的建议 汇集了流体和固体力学方面的广泛专业知识、基础设施和前期工作， 计算机模拟和血管生物学。这些发现将建立与临床相关的假设 将作为我们长期目标的基础；一项显示临床改善的大型随机对照试验 患者特有的分叉支架置入策略的结果。拟议中的研究是一个例子，说明了 精准医学配合术前计划有助于优化分叉支架置入术，提高临床水平 结果。特定患者的计算支架模拟可能会改变冠状动脉的管理模式 分叉介入治疗为如何改进支架置入术和术后扩张提供了新的视角 技巧。

PROTOCOL SUMMARY/ABSTRACT Coronary artery disease is the leading cause of death in Western society. Stents are implanted in 70-90% of the 1.3 million percutaneous coronary interventions performed annually in the USA, of which 20% involve bifurcations. Coronary bifurcations remain one of the most challenging lesion subsets in interventional cardiology, with a lower procedural success rate and increased rates of long-term adverse cardiac events, ranging between 15-20% at six months to one year post-intervention. Despite the great interest in this complex lesion subset, percutaneous treatment of coronary bifurcations is still a controversial subject and multiple technical strategies have been proposed. Fundamental mechanical disturbances within the stent appear to be major determinants of stent restenosis. No two bifurcations are identical, and no single treatment strategy exists that can be applied to every bifurcation. The most important issue in bifurcation interventions is selecting the most appropriate strategy for a specific bifurcation. Accordingly, we intend to investigate for the first time in human the role of fluid stresses on stent restenosis. We will use a validated subject-specific finite element analysis of arterial bifurcations rooted in clinical and experimental data to faithfully predict stent restenosis. The overall objective of this proposal is to use an individualized approach to identify the optimal bifurcation stenting technique for a specific bifurcation. Our central hypothesis is that subject-specific simulations of bifurcation stenting optimize the local biomechanical environment and reduces stent restenosis. Our proposal brings together extensive expertise, infrastructure and preliminary work in fluid and solid mechanics, computational simulations and vascular biology. These findings will establish clinically-relevant hypotheses that will serve as basis for our long term goal; a large, randomized controlled trial to show improved clinical outcomes with patient-specific bifurcation stenting strategies. The proposed research is an example of how precision medicine with pre-procedural planning can help optimize bifurcation stenting and improve clinical outcomes. Patient-specific computational stenting simulations may shift the management paradigm of coronary bifurcation interventions and provide a new dimension on how to improve the stenting and post-dilatation techniques.