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Assessment of intracranial arterial collateralisation and venous microperfusion profile to predict infarct evolution in patients with early ischemic stroke and endovascular treatment using machine learning models

使用机器学习模型评估颅内动脉侧支和静脉微灌注曲线，以预测早期缺血性中风患者的梗死进展和血管内治疗

基本信息

批准号：
411621970
负责人：
Privatdozent Dr. Tobias Djamsched Faizy
金额：
--
依托单位：
Department of Radiology
依托单位国家：
德国
项目类别：
Research Fellowships
财政年份：
2019
资助国家：
德国
起止时间：
2018-12-31 至 2020-12-31
项目状态：
已结题

来源：
https://gepris.dfg.de/gepris/projekt/411621970?language=en
关键词：
Assessment intracranial arterial collateralisation venous

项目摘要

Acute ischemic stroke (AIS) is defined as disruption of blood flow to the brain caused by an occlusion of a supplying vessel and subsequent oxygen deficiency of the dependent brain tissue. All AIS treatments seek to restore blood flow to the brain by dissolving or removing the clot blocking blood flow to the brain. Intravenous thrombolysis (tPA) has been the predominant treatment of AIS for over two decades. More recently, a minimally-invasive surgery called thrombectomy has been used to effectively remove the blood clot from the artery in the brain. In order to evaluate treatment options, the brain tissue and its blood circulation need to be examined by means of computer tomography or magnetic resonance imaging. On medical imaging, patients with a large amount of salvageable tissue usually show distinctive vessels called intracranial collaterals (IC). During AIS, IC refer to a subsidiary network of vascular channels and robust IC may temporarily preserve blood flow to otherwise critically hypoperfused brain areas thus pivotally effecting the quality of tissue perfusion. Consequently, tissue perfusion is governed by the in-flow of arterial blood to the brain tissue and its outflow into the cerebral veins. In recent years, most studies have focused on the arterial component of this conduit, but very little is known about the draining venous side of it. It has been proposed that determining the blood flow within the venous part of the microvascular system of AIS patients may even better reflect the overall quality of brain tissue perfusion, as it reflects blood flow after passing the brain tissue. It would be highly desirable to properly assess the venous microvascular perfusion status with medical imaging, as it holds crucial information about brain’s pathophysiology during AIS and may serve as an important biomarker for treatment decision making and patients’ clinical outcome. Another critical, yet unresolved question is, whether distinct medical treatment approaches would have notable effects on the robustness of venous microcirculation and treatment outcome. We have established a strong international collaboration between Stanford University (USA) and the University Medical Center Hamburg-Eppendorf (Germany) and generated one of the largest prospectively maintained databases of currently 650 AIS patients treated with tPA and thrombectomy. We propose to investigate the microvascular perfusion profile in AIS patients with a focus on venous out-flow microcirculation using multi-parametric CT and MRI prior to thrombectomy treatment. We aim to determine whether robust cortical venous microcirculation is influenced by intravenous thrombolysis and whether this parameter influences patient outcome. Our results will augment the understanding of cerebral microvascular pathophysiology during AIS and we strive to contribute to a better individual treatment selection and improved medical care to optimize clinical outcome for stroke patients.

急性缺血性中风(AIS)被定义为由于供血血管闭塞和随后依赖的脑组织缺氧而导致的脑血流中断。所有的AIS疗法都试图通过溶解或清除阻碍血液流向大脑的血块来恢复大脑的血液流动。二十多年来，静脉溶栓(TPA)一直是AIS的主要治疗方法。最近，一种名为血栓切除术的微创手术被用于有效地清除大脑动脉中的血块。为了评估治疗方案，需要通过计算机断层扫描或磁共振成像来检查脑组织及其血液循环。在医学成像上，有大量可挽救组织的患者通常会显示独特的血管，称为颅内侧支(IC)。在AIS中，IC指的是血管通道的附属网络，而强健的IC可以暂时保护血流到否则严重低灌流的脑区，从而对组织灌流质量产生关键影响。因此，组织的血流灌注是由动脉血流入脑组织和流出到脑静脉来控制的。近年来，大多数研究都集中在该管道的动脉成分上，但对其引流静脉的一侧知之甚少。有人提出，测定AIS患者微血管系统静脉部分的血流量可能更好地反映脑组织灌注的整体质量，因为它反映了通过脑组织后的血流量。通过医学成像正确评估静脉微血管的血流状态是非常必要的，因为它包含了有关AIS期间大脑病理生理学的关键信息，并可能作为治疗决策和患者临床结果的重要生物标志物。另一个关键但尚未解决的问题是，不同的医疗方法是否会对静脉微循环的稳健性和治疗结果产生显著影响。我们在美国斯坦福大学和德国汉堡-埃彭多夫大学医学中心之间建立了强有力的国际合作，并创建了目前接受tPA和血栓切除术治疗的650名AIS患者的最大预期维护数据库之一。我们建议在血栓切除治疗前使用多参数CT和MRI来研究AIS患者的微血管灌注情况，重点是静脉流出微循环。我们的目标是确定强劲的皮质静脉微循环是否受到静脉溶栓治疗的影响，以及这一参数是否影响患者的预后。我们的结果将加深对AIS期间脑微血管病理生理学的理解，并努力为更好的个体化治疗选择和改善医疗保健做出贡献，以优化中风患者的临床结果。