左心室尾闭塞:当前的中风预防策略和向数据驱动的,针对患者的方法转变
Keegan Mendez1,2, Darragh G Kennedy2,3, Dee Dee Wang4
1Harvard/MIT Health Sciences and Technology Program, Massachusetts Institute of Technology, Cambridge, Massachusetts.
概括
左心房附属体 (LAA) 阻塞旨在预防心房的患者中风,而这些患者不符合抗凝治疗的条件. 使用先进成像和建模的个性化方法有望改善设备-解剖学适应性和患者的结果.
科学领域:
- 心脏病学和医疗器械工程
- 生物医学成像和计算建模
背景情况:
- 左心房附属体 (LAA) 在心房动中与血栓形成和心血管栓塞事件有关.
- 目前的中风预防策略,包括口服抗凝药和皮肤间的LAA封闭,都有局限性.
- 设备-解剖学不匹配导致LAA封闭程序中不理想的结果.
研究的目的:
- 审查目前对LAA解剖学和病理生理学的理解.
- 评估现有的中风预防策略对于心房动.
- 探索新的以患者为中心的LAA封闭方法.
主要方法:
- 关于LAA解剖学,病理生理学和中风预防的最新文献的审查.
- 分析最近计算机断层扫描 (CT) 成像和手术前规划方面的进展.
- 对LAA封闭的计算建模和增材制造技术的评估.
主要成果:
- 在LAA形态学中显著的患者间异质性对当前的闭塞装置提出了挑战.
- 图像和建模方面的进步为改进设备选择和定制提供了潜力.
- 新技术促进了从患者解剖成像到患者特定解决方案的管道.
结论:
- 需要转向以患者为中心的LAA封闭的范式转变.
- 根据个体患者需求设计的定制,数据驱动的方法是必不可少的.
- 集成先进的成像,建模和制造可以提高LAA阻塞效率和患者的治疗结果.
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