1. ARTreat Vision

2. Atherosclerosis The 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”

3. Atherosclerosis The 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

4. 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 ARTreat The Concept

5. ARTreat The 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

6. 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) ARTreat Objectives 3D Visualization of the arterial tree Plaque formation and growth model

7. ARTreat Objectives Development and testing of Interventional Decision Support Tool –to choose –Support cardiologists to choose the most suitable stent-position Development and testing of a virtual- training environment for stent-positioning – –Virtual patient treatment – –Haptic interface possibility

8. ARTreat Training Tool ARTreat Benefits for the Stakeholders Changes in Cardiologists Work-Flow novices in medical school cardiologists patients Modalities severance estimation ARTreat modelling applications clinical interventions pharmacologic treatment decision, based on the plaque’s evolution model ARTreat Treatment Decision Support Tool ARTreat Intervention Support Tool

9. ARTreat Benefits 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 Patients Life

10. ARTreat The Scenario

11. 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 addressed by ARTreat

12. ARTreat Overall 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

13. decision support tools ARTreat Platform CT IVUS MRI Angiography training tools Modalities Project Applications Other medical exams (e.g. blood exams, genes, etc) patient specific diagnosis ARTreat

14. ARTreat OverAll Architecture

15. ARTreat Decision 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 }

16. ARTreat ARTreat Knowledge Timeline knowledge time imaging modalities CT, MRI, IVUS, angiographies 70’s – 80’s 90’s 00’s10’s 3D modelling -imaging techniques improvement blood flow and bio-process studies- cardiovascular system’s modelling ARTreat plaque progression model – time based integrated modelling

17. ARTreat Vision

18. Distribution of Deaths 1 - THE GLOBAL BURDEN OF DISEASE - 2004 UPDATE, World Health Organization

19. Atherosclerosis Formation 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

20. Atherosclerosis Formation

21. Computed Tomography

22. Intravascular Ultrasound

23. Magnetic Resonance Imaging

24. Angiography