Stroke treatment goes personalized: Gaining added diagnostic yield bycomputer-assisted treatment selection

中风治疗走向个性化：通过计算机辅助治疗选择提高诊断率

• 批准号: 326824585
• 负责人: Professor Dr. Björn Menze
• 金额: --
• 依托单位: Institut für Diagnostische, Interventionelle und Pädiatrische Radiologie
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2017
• 资助国家: 德国
• 起止时间: 2016-12-31 至 2021-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/326824585?language=en
• 关键词: Stroke; treatment; goes; personalized; Gaining

There is now class I evidence that mechanical thrombectomy is a safe and effective therapy within an estimated time frame of 6 h after stroke onset. Seven prospective studies have recently evidenced the superiority in proximal vessel occlusions (MR-CLEAN, ESCAPE, EXTEND-IA, SWIFT-PRIME, REVASCAT, THRACE, and THERAPY). Mechanical thrombectomy has thus become the treatment option of choice to achieve an early and sustained revascularization of proximally occluded vessels in tertiary care stroke centers. These studies have illustrated that mechanical thrombectomy using stent retrievers is a highly effective treatment with low complication rates. However, due to the narrow inclusion criteria and limed time window for treatment, the studies do not provide a guide for the majority of clinical patients1 who do not match inclusion criteria such as for example presentation beyond the time window of 6 hours of or with large infarct core at initial imaging. The aim of decision making for endovascular stroke treatment is to maximized the number of patients who will benefit from recanalization and minimized the patients will futile recanalization after endovascular stroke treatment. To facilitate this, an individualized prediction model of the neurological outcome in case of recanalization compared to the natural history is necessary.These studies have highlighted the potential to select patients based on the size of the penumbra and ischemic core, but have raised new questions to be solved: 'can we predict a benefit in tissue survival if mechanical thrombectomy is successfully applied compared to the natural course of disease'. This question is strongly dependent on the presence of 'sufficient vs. insufficient collaterals'. The availability of a fast, safe, reproducible and reliable information about the expected tissue salvage would allow us not only to select patients that would benefit from mechanical thrombectomy, it would also permit selection of patients for revascularization in a more flexible time window that might exceed 6 h if sufficient collateral flow enables sustained tissue survival. The goal of the project is to provide a system capable of assessing patient risk in acute stroke, based on imaging features and quantification of collateral flow derived from pre-interventional imaging. This information will benefit stroke patients, by providing neuroradiologists and stroke neurologists with a fast, accurate, repeatable interpretation of multiple disparate information sources. Evidence from our system will enable better treatment selection by refining the estimation of irreversibly damaged vs. potentially salvageable penumbral tissue and its respective lesion load on eloquent areas of the brain. An accurate computer-assisted treatment selection module offers the potential to select patients with stable collaterals and preserved penumbral from even beyond the currently recommended window of 6 hours after stroke onset.

目前有I类证据表明，在卒中发作后6小时的估计时间范围内，机械血栓切除术是一种安全有效的治疗方法。最近有7项前瞻性研究证明了近端血管闭塞的优效性（MR-CLEAN、ESCAPE、EXTEND-IA、SWIFT-PRIME、REVASCAT、THRACE和THERAPY）。因此，机械血栓切除术已成为三级卒中中心实现近端闭塞血管早期和持续血运重建的首选治疗方案。这些研究表明，使用支架取栓器的机械血栓切除术是一种高度有效的治疗方法，并发症发生率低。然而，由于狭窄的入选标准和有限的治疗时间窗，这些研究没有为大多数不符合入选标准的临床患者1提供指导，例如在初始成像时超过6小时的时间窗或具有大梗死核心。血管内卒中治疗决策的目的是最大限度地增加受益于再通的患者数量，并最大限度地减少血管内卒中治疗后无效再通的患者数量。为了促进这一点，一个个性化的预测模型的神经功能的结果，在再通的情况下相比，自然history.These研究强调了潜在的选择患者的基础上的大小的半影和缺血核心，但提出了新的问题要解决：“我们可以预测一个组织生存的好处，如果机械血栓切除术是成功地应用相比，自然病程的疾病”。这个问题在很大程度上取决于是否存在“充足的抵押品”。关于预期组织挽救的快速、安全、可再现和可靠信息的可用性不仅使我们能够选择将从机械血栓切除术中受益的患者，而且还允许在更灵活的时间窗内选择患者进行血运重建，如果足够的侧支血流能够维持组织存活，则时间窗可能超过6小时。该项目的目标是提供一种能够根据成像特征和介入前成像得出的侧支血流定量评估急性卒中患者风险的系统。这些信息将使卒中患者受益，为神经放射科医生和卒中神经科医生提供快速，准确，可重复的多个不同信息源的解释。来自我们系统的证据将通过改进对不可逆损伤与潜在可挽救的半影组织及其在大脑功能区上的相应病变负荷的估计来实现更好的治疗选择。准确的计算机辅助治疗选择模块有可能选择具有稳定侧支循环和保留半影的患者，甚至超过目前推荐的中风发作后6小时的窗口。