Gowda Prateek C, Weinstein Robert M, Bhargava Akanksha, Senarathna Janaka, Stewart Ryan Q, Ekbote Pallavi V, Singh Mantej, Guan Emily, Banghar Serena, Pathak Arvind P, Weiss Clifford R
Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 7203 Sheikh Zayed Tower, Suite 7, 1800 Orleans Street, Baltimore, MD, 21287, USA.
Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD, 21218, USA.
Cardiovasc Eng Technol. 2024 Dec;15(6):738-748. doi: 10.1007/s13239-024-00749-8. Epub 2024 Sep 16.
The development of new endovascular technologies for transarterial embolization has relied on animal studies to validate efficacy before clinical trials are undertaken. Because embolizations in animals and patients are primarily conducted with fluoroscopy alone, local hemodynamic changes are not assessed during testing. However, such hemodynamic metrics could be important indicators of procedure efficacy that could support improved patient outcomes, such as via the determination of procedural endpoints. The purpose of this study is to create a high-fidelity benchtop system for multiparametric (i.e., hemodynamic and imaging) assessment of transarterial embolization procedures.
The benchtop system consists of a 3D printed, anatomically accurate vascular phantom; a flow loop with a cardiac output simulator; a high-speed video camera; and pressure transducers and flow meters. This system enabled us to vary the heart rate and blood pressure and to simulate clinically relevant hemodynamic states, such as healthy adult, aortic regurgitation, and hypovolemic shock.
With our radiation-free angiography-mimetic imaging system, we could simultaneously assess gauge pressure and flow values during transarterial embolization. We demonstrated the feasibility of recapitulating the digital subtraction angiography workflow. Finally, we highlighted the utility of this system by characterizing the relationship between an imaging-based metric of procedural endpoint and intravascular flow. We also characterized hemodynamic changes associated with particle embolization within a branch of the hepatic artery and found them to be within reported patient data.
Our benchtop vascular system was low-cost and reproduced transarterial embolization-related hemodynamic phenomena with high fidelity. We believe that this novel platform enables the characterization of patient physiology, novel catheterization devices, and techniques.
用于经动脉栓塞的新型血管内技术的开发依赖于动物研究,以便在开展临床试验之前验证其疗效。由于动物和患者的栓塞主要仅通过荧光透视进行,因此在测试过程中不会评估局部血流动力学变化。然而,这些血流动力学指标可能是手术疗效的重要指标,有助于改善患者预后,例如通过确定手术终点。本研究的目的是创建一个用于经动脉栓塞手术多参数(即血流动力学和成像)评估的高保真台式系统。
该台式系统由一个3D打印的、解剖结构精确的血管模型;一个带有心输出量模拟器的血流回路;一台高速摄像机;以及压力传感器和流量计组成。该系统使我们能够改变心率和血压,并模拟临床相关的血流动力学状态,如健康成年人、主动脉瓣关闭不全和低血容量性休克。
借助我们的无辐射类血管造影成像系统,我们能够在经动脉栓塞过程中同时评估表压和流量值。我们证明了重现数字减影血管造影工作流程的可行性。最后,我们通过描述基于成像的手术终点指标与血管内血流之间的关系,突出了该系统的实用性。我们还描述了与肝动脉分支内颗粒栓塞相关的血流动力学变化,并发现它们与已报道的患者数据相符。
我们的台式血管系统成本低廉,能够高度逼真地再现经动脉栓塞相关的血流动力学现象。我们相信,这个新颖的平台能够对患者生理机能、新型导管装置和技术进行特性描述。