ARTreatARTreat

VisionVision

AtherosclerosisAtherosclerosisThe problemThe problem

Definition: “Atherosclerosis is a vascular disease associated with the accumulation of lipids leading to the invasion of leukocytes and smooth muscle cells into the intima, a process which may proceed to the formation of plaque on the wall of arteries and vessels”

AtherosclerosisAtherosclerosisThe FactsThe Facts

Atherosclerosis' connected diseases are the most common cause of death in western countries

Cardiologists, nowadays have two treatment options– Pharmacological treatment– Invasive Interventions treatment (e.g. stenting)

Problems regarding diagnosis and treatment methods– Pharmacological treatment have results when the disease is

recognized in an early phase

– Stenting changes local anatomy and blood flow dynamics, thus biologically triggering new sites of plaque formation

– Cardiologists must decide which treatment to apply, without any information about the disease’s evolution

ARTreat targets at providing a three-level, patient-specific computational model of the cardiovascular system

ARTreat will focus on the levels bellow – Multi level modelling

arteries’ geometry blood flow bio-molecular processes

– Plaque formation and propagation Predictive Simulation

– Decision Support Tools

– Training Tools

ARTreatARTreatThe ConceptThe Concept

ARTreatARTreatThe VisionThe Vision

We envision that – atherosclerotic plaque evolution model will

be the beginning of a new Screening Test

– cardiologists will acquire tools which will support them before, during and after a clinical intervention

– both novices and cardiologists will have the possibility to train and enhance their skills by conducting virtual interventions

Development and validation of patient-specific three-level model of the vasculature, integrating – artery anatomy– blood flow– particle dynamics

Development and testing of Treatment Decision Support Tool– estimation of the severity of a current situation – potential clinical outcomes (e.g. plaque rapture, artery

stenosis)

ARTreatARTreatObjectivesObjectives

3D Visualization of the arterial tree

Plaque formation and growth model

ARTreatARTreatObjectivesObjectives

Development and testing of Interventional Decision Support Tool – Support cardiologists to choose to choose the most

suitable stent-position

Development and testing of a virtual-training environment for stent-positioning– Virtual patient treatment– Haptic interface possibility

ARTreat Training Tool

ARTreat ARTreat Benefits for the StakeholdersBenefits for the Stakeholders

Changes in Changes in CardiologistsCardiologists Work-Flow Work-Flow

novices in medical school

cardiologists patients

Modalities

severance estimation

ARTreat modelling

applications

clinicalinterventions

pharmacologictreatment

treatmentdecision, based on

the plaque’s evolution model

ARTreat Treatment Decision

Support Tool

ARTreat Intervention Support Tool

ARTreatARTreatBenefits for the StakeholdersBenefits for the Stakeholders

Using the plaque evolution model– the diagnose of atherosclerotic diseases will be

achieved earlier and be more accurate

– the number of needed examinations will be reduced, especially the ones which require an intervention process

Examinations’ Cost will be decreased

The possibility of accessional interventions after a stent positioning will be minimized

Changes in Changes in PatientsPatients Life Life

ARTreatThe Scenario

ARTreat ARTreat

What kind of treatment should I use to a patient? Should I use a stent for a his treatment or not?

Which kind of stent should I use?

Which is the best position to place the stent?

How much time I have in order to conduct the stenting procedure to a patient?

Am I prepared well enough to conduct an interventional process to a specific patient?

Cardiologists questions that will be Cardiologists questions that will be addressed by addressed by ARTreatARTreat

ARTreatARTreatOverall ImpactOverall Impact

Healthcare productivity– enhance cardiologists skills– enhance cardiologists ability to take more informed

decisions– ease accumulation of new knowledge

Healthcare quality of service– assist the provision of personalised treatments– assist the patient into gaining a greater understanding of

the effects of his actions to his health

Lives Savings– minimise future invasive interventions– provide appropriate medical assistance to individualised

problems– optimise medical intervention– prevent possible interventional errors

decision support

tools

ARTreatARTreatPlatformPlatform

CT

IVUS

MRI

Angiographytraining

tools

Modalities Project Applications

Other medical exams (e.g.

blood exams, genes, etc)

patient specific diagnosis

ARTreat

ARTreatARTreatOverAll ArchitectureOverAll Architecture

Heterogeneous Data Bases

Data Mining

Plaque Characterization

Image modalities Patient

Specific 3D Modeler

Other medical exams (e.g.

blood exams)

Interventional Decision Support

Treatment Decision Support

PredictionPlaque Vulnerability

Plaque Rupture

PersonalizedTreatment

Training Tools

PersonalizedBlood Flows

for stent positioning

ARTreatARTreatDecision Support ToolsDecision Support Tools

Treatment Decision Support Tool– Diagnosis

plaque characterization plaque evolution

– Pre and Post operative support

Interventional Decision Support Tool– Surgery assistance

stent positioning– Support During operations – real time response

Training Tool– Educational platform– Hands – on training for stent positioning

treatment decision}

positioning

decision}

ARTreatARTreatKnowledge Timeline

knowledge

time

imaging modalitiesCT, MRI, IVUS, angiographies

70’s – 80’s 90’s 00’s 10’s

3D modelling-imaging techniques

improvement

blood flow andbio-process studies-

cardiovascular system’s modelling

ARTreatplaque progression model –

time based integrated modelling

ARTreatARTreat

VisionVision

Distribution of Deaths

1 - THE GLOBAL BURDEN OF DISEASE - 2004 UPDATE, World Health Organization

AtherosclerosisAtherosclerosis FormationFormation

low-density lipoprotein molecules (LDL)

becoming oxidized (LDL-ox) by oxygen

free radicals inside the arteries

How does atherosclerosis form?

more white blood cells

are triggered from the immune system

body's immune system responds to the damage to the artery wall caused by

LDL-ox by sending Specialized white blood

cells to absorb the LDL - ox

these white blood cells are not able to

process the LDL-ox, and ultimately form ruptures,

depositing a greater amount of oxidized

cholesterol into the artery wall

AtherosclerosisAtherosclerosis FormationFormation

Computed Tomography

Intravascular Ultrasound

Magnetic Resonance Imaging

Angiography