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，景观 中风患者的管理一直在通过血管内机械血栓切除术（EVT）发生变化 年。 EVT是从脑动脉去除引起中风的血栓（凝块）的介入程序 诱导重新定性。有理由认为，安全性和效率将继续进行EVT的进一步改善 改善中风结果。 EVT成功的关键之一是使用灌注成像的患者选择 评估下游血管床和抵押品的生存能力。可挽救的组织可能会受益 从EVT的再灌注中，而后核后出血转化（HT）的风险更大 当梗塞（死组织）大小很大时（> 50–70 mL）。脑侧外循环可挽救的组织 可行并减慢基础设施核心的增长；但是，侧支循环的强度强烈 随着时间的流逝，患者和患者之间会变得不足（即使在时间窗口中 提供EVT）。因此，必须使用使用 灌注成像；但是，当前护理标准的问题是无法实时执行 术中脑灌注成像。在这个项目中，我们建议开发一种名为ipen v2的新方法 使用标准X射线血管造影在介入套件中执行定量脑灌注成像 图像。 IPEN（干预内灌注而没有龙门旋转）将提供介入的放射科医生 关键，实时的信息采取多个步骤以安全，更有效地执行EVT。在R21下 项目，我们开发了IPEN V1，可以评估多个体积区域的3D组织许可 直接来自血管造影图像的兴趣（ROI）。肝肿瘤肿瘤学的模拟研究表明 即使ROI在血管造影图像中重叠，灌注指标也是准确的。以此为基础 基础，该项目的具体目的1是开发用于大脑灌注评估的IPEN V2。具体目标2 是使用患者数据验证iPen V2。我们将追溯访问300组中风患者数据 通过护理标准获得并验证具有多个方面的iPen。特定目标3是评估ipen v2 使用计算机模拟数据。到该项目结束时，我们将拥有IPEN V2完全开发和验证 为了实现EVT的必要改进。然后，我们将与制造商开始对话 在其血管造影系统中实现IPEN。