Development of a novel method for detailed evaluation of blood flow patterns in stented segments and assessment of their role in stent thrombosis
Lead Research Organisation:
Queen Mary University of London
Department Name: William Harvey Research Institute
Abstract
Stents are used today to treat the blockages of the vessels of the heart in patients who have angina or suffered a heart attack. In most of these patients, stent treatment is effective and improves symptoms and life expectancy. However, there is a small proportion of patients where the stents fail and block, causing either death or a major heart attack. Studies in animals have shown that the blood flow patterns following stent implantation can predict stents that are at risk to block. However, there is lack of data about the role of blood flow on stent blockage in humans. This is because it is very difficult to create models of the vessels of the heart that have been treated with stents.
This study aims to address this problem. We will analyse images of the vessels of the heart taken by a wire that is advanced in these vessels. In these images we can see details of the vessel wall and of the stent. We will use these images to create models of the vessels treated with stents using a new method that we have developed and then we will simulate blood flow in these models to assess the flow patterns. We will do that at scale in 120 patients of whom 40 had a heart attack because of a blocked stent. We will then compare the flow patterns in stents that blocked and caused a heart attack and in vessels treated with stents that did not cause an event. We believe that this research will allow us to identify the flow patterns that can cause stent blockage. This information is important as it will help us to improve the design of future stents and also the way that we put stents so as to reduce the risk of stent blockage and future heart attacks.
This study aims to address this problem. We will analyse images of the vessels of the heart taken by a wire that is advanced in these vessels. In these images we can see details of the vessel wall and of the stent. We will use these images to create models of the vessels treated with stents using a new method that we have developed and then we will simulate blood flow in these models to assess the flow patterns. We will do that at scale in 120 patients of whom 40 had a heart attack because of a blocked stent. We will then compare the flow patterns in stents that blocked and caused a heart attack and in vessels treated with stents that did not cause an event. We believe that this research will allow us to identify the flow patterns that can cause stent blockage. This information is important as it will help us to improve the design of future stents and also the way that we put stents so as to reduce the risk of stent blockage and future heart attacks.
Technical Summary
Cumulative data have demonstrated that the local haemodynamic forces regulate endothelial function following stent implantation and stimulate pathophysiological mechanisms that modulate neointima proliferation and platelet activation leading to in-stent restenosis and stent thrombosis. Over the last years numerous in vivo studies have allowed us to identify haemodynamic predictors of in stent restenosis, however, there is limited clinical data today about the role of the local haemodynamic forces on stent thrombosis. This should be attributed to the low incidence of stent thrombosis and to the fact that the evaluation of the haemodynamic micro-milieu, that regulates platelet activation and thrombus formation, requires detailed reconstruction of the lumen architecture, including protruding and malapposed stent struts, which is not feasible with the conventional reconstruction techniques. In this application we aim to overcome these limitations and 1) develop an advanced methodology that relies on the separate reconstruction of the lumen and stent geometry to accurately model stented segments, 2) examine the efficacy of the advanced and of a conventional reconstruction methodology in generating geometrically correct models in bench studies and in vivo, 3) compare the haemodynamic micro-milieu estimated in models reconstructed by the advanced approach and in those derived by the conventional methodology and 4) use the advanced method to reconstruct stented segments that were thrombosed and caused events and segments that remained quiescent and examine the role of the local haemodynamic forces in stent thrombosis.
Organisations
- Queen Mary University of London (Lead Research Organisation)
- MedStar Health Research Institute (Collaboration)
- Medical University of Warsaw (Collaboration, Project Partner)
- King's College Hospital NHS Foundation Trust (NCH) (Collaboration)
- University Hospital La Princesa (Collaboration)
- University of Galway (Collaboration)
- MANCHESTER UNIVERSITY NHS FOUNDATION TRUST (Collaboration)
- McMaster University (Collaboration)
- NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST (Collaboration)
- Nara University (Collaboration)
- National Heart Centre Singapore (Collaboration)
- University Hospitals Bristol and Weston NHS Foundation Trust (Collaboration)
- Columbia University (Collaboration)
- Fujita Health University (Collaboration)
- San Carlos University Hospital (Collaboration)
- LEEDS TEACHING HOSPITALS NHS TRUST (Collaboration)
- Shinshu University (Collaboration)
- San Giovanni Addolorata Hospital (Collaboration, Project Partner)
- ROYAL FREE LONDON NHS FOUNDATION TRUST (Collaboration)
- University Hospitals Sussex NHS Foundation Trust (Collaboration)
- Radboud University Nijmegen Medical Center (Collaboration)
- Queen Elizabeth Hospital Birmingham (Collaboration)
- Harbin Medical University (Collaboration)
- Liverpool Heart and Chest Hospital NHS Foundation Trust (Collaboration)
- Yale University (Collaboration)
- Yonsei University (Collaboration)
- Oxford University Hospitals NHS Foundation Trust (Collaboration)
- Erasmus MC (Collaboration)
- John Radcliffe Hospital (Project Partner)
- MedStar Georgetown University Hospital (Project Partner)
- Leiden University (Project Partner)
- ASST Papa Giovanni XXIII Hospital (Project Partner)
- Univ Hosp Bristol & Weston NHS Fdn Trust (Project Partner)
- Royal Free London NHS Foundation Trust (Project Partner)
| Title | New methodology for the reconstruction of stented vessels from OCT and angiographic data |
| Description | We have developed a new method that is able to generate models of stented segments with a high accuracy. The method performs two different reconstructions: the first involves reconstruction of the stent geometry and the second of the coronary artery and then fuses these two geometries in a single model. In vivo testing in 16 coronary arteries and in silicone models has shown that is very accurate in reconstructing vessel anatomy and enables reliable estimation of the flow patterns. A publication has been prepared and submitted to Atherosclerosis. |
| Type Of Material | Improvements to research infrastructure |
| Year Produced | 2025 |
| Provided To Others? | No |
| Impact | This development is expected to allow us analysis of large datasets and evaluation of the flow patterns on stent failure. |
| Description | Data sharing |
| Organisation | Columbia University |
| Department | Columbia University Irving Medical Center (CUIMC) |
| Country | United States |
| Sector | Hospitals |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Erasmus MC |
| Country | Netherlands |
| Sector | Hospitals |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Fujita Health University |
| Country | Japan |
| Sector | Academic/University |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Harbin Medical University |
| Country | China |
| Sector | Academic/University |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | King's College Hospital NHS Foundation Trust (NCH) |
| Country | United Kingdom |
| Sector | Public |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Leeds Teaching Hospitals NHS Trust |
| Country | United Kingdom |
| Sector | Public |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Liverpool Heart and Chest Hospital NHS Foundation Trust |
| Country | United Kingdom |
| Sector | Public |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Manchester University NHS Foundation Trust |
| Country | United Kingdom |
| Sector | Public |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | McMaster University |
| Department | Faculty of Health Sciences |
| Country | Canada |
| Sector | Academic/University |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | MedStar Health Research Institute |
| Country | United States |
| Sector | Charity/Non Profit |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Medical University of Warsaw |
| Country | Poland |
| Sector | Academic/University |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Nara University |
| Country | Japan |
| Sector | Academic/University |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | National Heart Centre Singapore |
| Country | Singapore |
| Sector | Hospitals |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Newcastle upon Tyne Hospitals NHS Foundation Trust |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Oxford University Hospitals NHS Foundation Trust |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Queen Elizabeth Hospital Birmingham |
| Country | United Kingdom |
| Sector | Hospitals |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Radboud University Nijmegen Medical Center |
| Country | Netherlands |
| Sector | Academic/University |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Royal Free London NHS Foundation Trust |
| Country | United Kingdom |
| Sector | Public |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | San Carlos University Hospital |
| Country | Spain |
| Sector | Hospitals |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | San Giovanni Addolorata Hospital |
| Country | Italy |
| Sector | Hospitals |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Shinshu University |
| Country | Japan |
| Sector | Academic/University |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | University Hospital La Princesa |
| Country | Spain |
| Sector | Hospitals |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | University Hospitals Bristol and Weston NHS Foundation Trust |
| Country | United Kingdom |
| Sector | Hospitals |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | University Hospitals Sussex NHS Foundation Trust |
| Country | United Kingdom |
| Sector | Hospitals |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | University of Galway |
| Country | Ireland |
| Sector | Academic/University |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Yale University |
| Department | School of Medicine |
| Country | United States |
| Sector | Academic/University |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |
| Description | Data sharing |
| Organisation | Yonsei University |
| Country | Korea, Republic of |
| Sector | Academic/University |
| PI Contribution | N/A |
| Collaborator Contribution | The centre has agreed to be a participant in the study and provide case of stent thrombosis that had OCT-guided PCI |
| Impact | The data analysis is still ongoing. |
| Start Year | 2024 |