腔内移植物与主动脉管壁的相互作用及其对主动脉夹层腔内隔绝术预后的影响

项目名称： 腔内移植物与主动脉管壁的相互作用及其对主动脉夹层腔内隔绝术预后的影响

项目编号： No.81330034

项目类型： 重点项目

立项/批准年度： 2014

项目学科： 医药、卫生

项目作者： 景在平

作者单位： 中国人民解放军第二军医大学

项目金额： 290万元

中文摘要： 主动脉夹层是指血流撕裂主动脉壁，易发生主动脉破裂致死，病情凶险。血管腔内移植物隔绝裂口实现微创治疗，已成为除传统开放手术之外介入治疗主动脉夹层的重要方法，但内漏、移植物边缘再发夹层等不良预后严重阻碍这一新技术的发展。我们前期研究表明：腔内移植物放置于发生夹层的主动脉特定区域，其差异构型与管壁、血流相互作用产生的生物力学效应与不良预后密切相关，具体机制和调控效应亟待阐明。本项目拟：①分析临床资料，筛选不良预后的危险因素，为力学分析和干预提供关键靶点；②通过计算机模拟不良预后病例的流体-固体力学耦合分析，以及研究相应的管壁组织学和应力应变性质改变，阐明不良预后的生物力学机制；③在动物模型上检验根据力学模拟改进构型的腔内移植物预防不良预后的效能，从而得到并验证不良预后的风险评估模型。本研究有助于阐明腔内隔绝术后不良预后的发生机制，为进一步提高主动脉疾病微创介入治疗水平提供重要的科学依据。

中文关键词： 腔内移植物;主动脉夹层;微创介入治疗;预后;生物力学

英文摘要： Endovascular stent-graft repair was introduced as an important alternative to conventional open surgery for the treatment of aortic dissections. But studies reported various complications caused by stent-grafts, such as endoleaks, stent graft-induced new entry, which are not rare complications and with high mortalities. Despite of its importance, investigation on this aspect has been least carried out and the underlying mechanisms are still unknown. ..As an alien objective, the endograft is much stiffer than the host arterial tissues. Moreover, when it is deployed, it can induce high mechanical stress concentrations over the contact region. Therefore the hypothesis of this study is the high stress concentration induced by the dismatch between the endograft and the aortic wall, and the local hymodynamic effects response for the onset of complications...This study will be conducted in three aspects: First, retrospectively analyze the clinical data to sieve out the targets for following biomechanical analysis; Second, accurately calculate and depict the stress concentration over the contact region on cases with complications, by computational hemodynamic simulation and the mechanical analyses of the interaction between the endograft and the aortic wall. These analyses will explain the associations between morphological features and the subsequent clinical events; Third, according to above mechanical analyses, modify the configuration of the stent-graft and use it on the animal model of aortic dissection. Then, test and analyze the biomechanical effects on the aorta as a whole, as well as on the local artery tissue of different contact regions. At last, integrating these results into a hazard regression model will help to find out the histologic evidence of the mechanical and hymodynamic effects, and to identify the best stent-graft configuration for respective aortic dissection...This study will provide important in-sight on the mechanism of stent graft-related complications, and it will be essential for optimizing the stent-graft design to preferably match the aortic dissection configuration. As biomechanical rationales of endovascular treatment of aortic dissection, the outcomes of this study may have great clinical potential.

英文关键词： stent-graft;aortic dissection;interventional therapy;prognosis;biomechanics