Assessing brain perfusion using IPEN during intra-arterial stroke intervention

动脉内卒中干预期间使用 IPEN 评估脑灌注

• 批准号: 10417557
• 负责人: Katsuyuki Taguchi
• 金额: $ 65.66万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10417557
• 关键词: 3-Dimensional; Agreement; Angiography; Arteries; Blood flow; Brain; Brain region; Cerebral Angiography; Cerebral Infarction; Cerebrum; Coagulation Process; Collateral Circulation; Computers; Data; Death Rate; Distal; Foundations; Growth; Head; Hemorrhage; Hour; Image; Infarction; Intervention; Ischemia; Ischemic Stroke; Lesion; Letters; Liver neoplasms; Magnetic Resonance; Measures; Mechanics; Medical; Methods; Motion; Oncology; Outcome; Patient Admission; Patient Selection; Patients; Perfusion; Perfusion Weighted MRI; Procedures; Reperfusion Therapy; Retrieval; Risk; Roentgen Rays; Rotation; Safety; Scheme; Stroke; System; Techniques; Testing; Thrombectomy; Thrombus; Time; Tissue Viability; Tissues; United States; Veins; Work; X-Ray Computed Tomography; acute stroke; arm; blood-brain barrier permeabilization; cerebral artery; digital; disability; functional outcomes; improved; indexing; interest; novel; perfusion imaging; radiologist; risk benefit ratio; simulation; standard of care; stroke intervention; stroke outcome; stroke patient; success; thrombolysis; vascular bed

Project Summary Ischemic stroke is the leading cause of long-term disability in the United States. Fortunately, the landscape of stroke patient management has been changing by endovascular mechanical thrombectomy (EVT) in recent years. EVT is an interventional procedure to remove a stroke-causing thrombus (clot) from a cerebral artery to induce recanalization. It stands to reason that further improvements of EVT in safety and efficacy will continue to improve stroke outcomes. One key to the success of EVT is patient selection using perfusion imaging that assesses the viability of the downstream vascular bed and collaterals. Salvageable tissue will likely benefit from reperfusion by EVT, whereas the risk of post-recanalization hemorrhagic transformation (HT) is larger when infarct (dead tissue) size is large (>50–70 ml). Cerebral collateral circulation keeps salvageable tissue viable and slows down the infarct core growth; however, the strength of the collateral circulation varies strongly between patients and it is expected to become insufficient over time (even within the time window in which EVT is offered). Therefore, it is essential to assess the risk–benefit ratio of EVT for each patient using perfusion imaging; however, the problem with the current standard of care is an inability to perform real-time, intra-operative brain perfusion imaging. In this project, we propose to develop a novel method called IPEN v2 to perform quantitative brain perfusion imaging in the interventional suite using standard x-ray angiography images. IPEN (Intra-intervention PErfusion with No gantry rotation) will provide the interventional radiologist critical, real-time, information to take multiple steps to perform EVT safely and more effectively. Under an R21 project, we developed IPEN v1 which can assess the 3D tissue perfusion of multiple volumetric regions-of- interest (ROIs) directly from angiography images. A simulation study for liver tumor oncology showed that the perfusion indices were accurate even though ROIs were overlapped in angiography images. Building upon this foundation, Specific Aim 1 of this project is to develop IPEN v2 for brain perfusion assessment. Specific Aim 2 is to validate IPEN v2 using patient data. We will retrospectively access 300 sets of stroke patient data acquired via standard of care and validate IPEN with multiple aspects. Specific Aim 3 is to assess IPEN v2 using computer simulated data. By the end of this project, we will have IPEN v2 fully developed and validated to enable the necessary improvements of EVT. We will then start the conversation with manufactures for implementing IPEN in their angiography systems.

项目摘要 缺血性中风是美国长期残疾的主要原因。幸运的是， 近年来，血管内机械血栓切除术（EVT）改变了卒中患者的管理 年EVT是一种介入手术，用于从脑动脉中清除导致卒中的血栓（凝块）， 诱导再通。按理说，EVT在安全性和有效性方面的进一步改进将继续下去 来改善中风的预后EVT成功的一个关键是使用灌注成像选择患者， 评估下游血管床和侧枝的活力。可挽救的组织可能会受益于 通过EVT再灌注，而再通后出血性转化（HT）的风险更大 当梗塞（死亡组织）尺寸较大（>50-70 ml）时。大脑侧支循环保持可挽救的组织 存活并减缓梗死核心生长;然而，侧支循环的强度变化很大 在患者之间，并且随着时间的推移，预计它将变得不足（即使在其中 提供EVT）。因此，必须使用以下方法评估每例患者EVT的风险受益比： 灌注成像;然而，当前护理标准的问题是不能进行实时， 术中脑灌注成像。在这个项目中，我们建议开发一种称为IPEN v2的新方法 使用标准X射线血管造影术在介入室中进行定量脑灌注成像 图像. IPEN（无机架旋转的介入内灌注）将为介入放射科医生提供 关键的实时信息，以采取多个步骤来安全和更有效地执行EVT。根据R21 项目，我们开发了IPEN v1，它可以评估多个体积区域的三维组织灌注， 感兴趣区域（ROI）。肝脏肿瘤学的模拟研究表明， 即使ROI在血管造影图像中重叠，灌注指数也是准确的。在此基础上 该项目的具体目标1是开发用于脑灌注评估的IPEN v2。具体目标2 使用患者数据验证IPEN v2。我们将回顾性地访问300组中风患者的数据， 通过标准护理获得，并从多个方面验证IPEN。具体目标3是评估国际消除持久性有机污染物网络v2 使用计算机模拟数据。到本项目结束时，我们将完全开发和验证IPEN v2 以实现EVT的必要改进。然后，我们将开始与制造商的对话， 在血管造影系统中实施IPEN。