主动脉弓部病变腔内治疗相关非牛顿血流动力学机制及应用研究

With the improvement and rapid development of endovascular technology, the treatment of aortic diseases has entered a brand new ‘Endo’ era. However, aortic arch lesions have been the bottleneck of endovascular therapy, due to the special location and complex anatomical morphology. Computational fluid dynamics has become a hot topic in biomechanical research, as it can provide some hemodynamic parameters that are difficult to obtain by routine imaging, since it was used to simulate cardiovascular diseases. In recent years, our group has actively explored endovascular therapy in treating aortic arch lesions, especially with the ‘Chimney’ and ‘Fenestration’ techniques to researve the branches, and we have built the computational fluid dynamic platform to study the hemodynamics of aortic arch diseases. Based on the problems in clinical practice, the current project will introduce the factors such as non-Newtonian rheological property of blood, slippage of the endothelium, and viscoelastic properties of aortic wall in the numerical analysis of aortic arch diseases, thus to establish the simulation close to real conditions. We will investigate the non-Newtonian hemodynamic mechanisms of aortic arch diseases and the complications of endovascular therapy，as well as build mathematical models and virtual platform of prediction value. And the application value of computational fluid dynamics will be explored in clinical practice, including preoperation evaluation, operation scheme optimizing and prognosis judgment. The work is promising to provide new ideas and strategies for risk evaluation and individualized diagnosis and treatment of aortic arch diseases.

随着血管腔内技术的不断改进与飞速发展，主动脉疾病的治疗已进入全新的腔内时代。主动脉弓部病变，由于其位置特殊，解剖形态复杂，一直是腔内治疗的瓶颈。计算流体力学用于模拟心血管疾病，可获得常规影像检测难以得到的血流动力学参数，已成为生物流体力学研究的热点。本课题组在前期工作中积极探索了主动脉弓部病变的腔内治疗，尤其擅长以“烟囱”和“开窗”技术保留弓上分支，并且初步建立了主动脉计算流体力学研究的方法。本课题拟从临床实际问题出发，在主动脉弓部疾病的数值分析中创新性引入血液的非牛顿流变性、内膜滑移和血管壁粘弹性等因素，以实现更接近真实情况的计算流体力学模拟，并深入研究主动脉弓部疾病发生发展以及腔内手术并发症相关的非牛顿血流动力学机制，建立具有预测价值的数学模型和虚拟平台，探讨计算流体力学在术前评估、手术优化及预后判断等方面的应用价值，为临床主动脉弓部疾病的个性化诊疗及风险预测开拓新的思路和策略。

随着血管腔内技术的不断改进与飞速发展，主动脉疾病的治疗已进入全新的腔内时代。主动脉弓部病变，由于其位置特殊，解剖形态复杂，一直是腔内治疗的瓶颈。计算流体力学用于模拟心血管疾病，可获得常规影像检测难以得到的血流动力学参数，已成为生物流体力学研究的热点。在本项目中，我们系统研究了主动脉形态学以及血流动力学特点对主动脉夹层的预测和风险评估的作用及价值，发现主动脉的弓部类型、弓部角度、升主动脉体积、远端主动脉弓的长度、弓部的弯曲度与主动脉夹层相关，并阐述了其血流动力学机制；我们引入微分几何的3D曲率和挠率参数从局部 “弯曲” 和 “扭转” 两个角度表征主动脉在空间上的扭曲程度；我们探讨了主动脉缩窄后远端扩张的血流动力学特点及相关机制；基于血液、支架和血管壁之间的相互耦合作用，我们通过流固耦合模拟定量评估支架植入对主动脉壁间血肿的影响；我们应用血流动力学定量分析主动脉支架置入前后肾动脉血流和灌注的血流动力学变化；基于三维离散相耦合FSI 模型，我们探讨了载药纳米颗粒动脉粥样硬化的靶向治疗作用。本项目深入探讨了形态学和计算流体力学在主动脉弓部疾病的相关机制和应用价值，为临床个性化诊疗及风险预测开拓了新的思路和策略。