Menichini Claudia, Cheng Zhuo, Gibbs Richard G J, Xu Xiao Yun
Department of Chemical Engineering, Imperial College London, London SW7 2AZ, UK.
Vascular Surgical Unit, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK.
J Biomech. 2018 Jan 3;66:36-43. doi: 10.1016/j.jbiomech.2017.10.029. Epub 2017 Nov 11.
Thoracic endovascular repair (TEVAR) has recently been established as the preferred treatment option for complicated type B dissection. This procedure involves covering the primary entry tear to stimulate aortic remodelling and promote false lumen thrombosis thereby restoring true lumen flow. However, complications associated with incomplete false lumen thrombosis, such as aortic dilatation and stent graft induced new entry tears, can arise after TEVAR. This study presents the application and validation of a recently developed mathematical model for patient-specific prediction of thrombus formation and growth under physiologically realistic flow conditions. The model predicts thrombosis through the evaluation of shear rates, fluid residence time and platelet distribution, based on convection-diffusion-reaction transport equations. The model was applied to 3 type B aortic dissection patients: two TEVAR cases showing complete and incomplete false lumen thrombosis respectively, and one medically treated dissection with no signs of thrombosis. Predicted thrombus growth over time was validated against follow-up CT scans, showing good agreement with in vivo data in all cases with a maximum difference between predicted and measured false lumen reduction below 8%. Our results demonstrate that TEVAR-induced thrombus formation in type B aortic dissection can be predicted based on patient-specific anatomy and physiologically realistic boundary conditions. Our model can be used to identify anatomical or stent graft related factors that are associated with incomplete false lumen thrombosis following TEVAR, which may help clinicians develop personalised treatment plans for dissection patients in the future.
胸主动脉腔内修复术（TEVAR）最近已成为复杂B型主动脉夹层的首选治疗方案。该手术包括覆盖主要入口撕裂处，以刺激主动脉重塑并促进假腔血栓形成，从而恢复真腔血流。然而，TEVAR术后可能会出现与假腔血栓形成不完全相关的并发症，如主动脉扩张和支架移植物引起的新入口撕裂。本研究展示了一种最近开发的数学模型的应用和验证，该模型可在生理现实流动条件下对患者特异性血栓形成和生长进行预测。该模型基于对流-扩散-反应输运方程，通过评估剪切率、流体停留时间和血小板分布来预测血栓形成。该模型应用于3例B型主动脉夹层患者：2例TEVAR病例分别显示假腔血栓形成完全和不完全，1例药物治疗的夹层无血栓形成迹象。根据随访CT扫描验证了预测的血栓随时间的生长情况，结果表明在所有病例中预测值与体内数据吻合良好，预测和测量的假腔缩小之间的最大差异低于8%。我们的结果表明，基于患者特异性解剖结构和生理现实边界条件，可以预测B型主动脉夹层中TEVAR诱导的血栓形成。我们的模型可用于识别与TEVAR术后假腔血栓形成不完全相关的解剖或支架移植物相关因素，这可能有助于临床医生未来为夹层患者制定个性化治疗方案。
