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

项目摘要/摘要 特发性颅内高压(IIH)是一种严重的病理性颅内压升高，可 导致失明、认知能力下降、衰弱头痛和令人痛苦的搏动性耳鸣(PT)。IIH MOST 通常发生在超重的育龄妇女中，虽然它的发病率为每10万人中有20人 在这一患者队列中，患病率随着肥胖症流行的扩大而不断增加。静脉窦 支架置入术(VSS)是一种很有前途的治疗IIH的新兴疗法，即操作者在大脑内植入支架 静脉窦血管内技术。而VSS具有良好的疗效、复发率和 在并发症发生率方面，仍有很大的改善空间。VSS患者的IIH复发是典型的 这是由于VSS近端边缘狭窄的发展。导致边缘狭窄的流动条件 发展是未知的。此外，并不是所有患者的PT在VSS后都有持久的消退。PT IS 通常归因于静脉血流异常，也受IIH影响，但具体原因是 IIH中PT的回归也是未知的。对大多数颅内支架内血流动力学的评估不是 由于其高金属含量，通过传统成像技术是可能的。在这个项目中，我们将 进行一项系统研究，首先开发改进的磁共振压力测量方法 静脉考虑湍流，开发灵活的壁患者特有的流动模型，解释 脑静脉窦独特的环境，磁共振方法测量其中的速度场 模型以及计算流体动力学，以询问无法在中轻松操作的要素 活体或在模型中。这些技术的进步将允许对血流动力学的稳健描述， 包括压力和湍流，这存在于治疗前和治疗后的患者中。我们会 将所获得的血流动力学变量、几何变量和生物变量与纵向变量进行比较 对接受VSS治疗的IIH患者进行评估，以确定每个变量对修订要求的优势比 对手术和PT复发进行回归分析。这些数据将被用于开发一种临床工具 旨在帮助医生为每个患者确定理想支架尺寸的原型。

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.