CEREBROVASCULAR RESERVE BY XE/CT VERSUS TCD AND OXIMETRY

描述：（摘自申请人摘要）Ronda Pindzola拥有生物心理学博士学位，曾在俄亥俄州立大学解剖学和凯斯西储大学神经科学专业获得博士后奖学金。从那以后，她进入了临床研究领域，在过去的四年里，她一直与dr。Yonas和Nemoto对SAH或颈动脉狭窄/闭塞患者的研究。她的长期目标包括研究影响中风风险的因素，以改善脑血管疾病患者的治疗方法。尽管pinzola博士在研究方面有扎实的背景，但她需要在临床研究方面的进一步培训，如诊断研究的解释、流行病学和统计学。Nemoto博士和Yonas博士非常适合作为她的导师和共同导师，因为他们在脑血管疾病的临床研究中有着不同的背景。pinzola博士还有一个多学科的研究团队，包括神经放射学家、神经外科医生、血管外科医生和一名流行病学家/统计学家，除了在研究的其他方面提供指导外，还帮助她招募患者。多项研究表明，经颅多普勒超声（TCD）和稳定的氙增强计算机断层扫描（Xe/CT）脑血流量（CBF）测量可以识别血流动力学受损和卒中高风险。本研究的目的是确定Xe/CT CBF与TCD和近红外光谱（NIRS）测量之间的关系，以便最好地识别脑血管储备受损患者。狭窄程度与脑血管储备的关系也将被研究，因为脑血管储备可能比狭窄程度更能指示中风的风险。假设是，用Xe/CT CBF方法测量脑血管储备，将使研究人员能够最好地识别储备严重受损的患者，从而使后续中风的风险最大。Pindzola博士希望将来将这项研究扩展到无症状患者。最近的几项研究表明，无症状颈动脉狭窄患者受益于颈动脉内膜切除术。然而，ACAS试验发现，需要对17名患者进行手术才能在5年内预防一次中风或死亡。为了获得预防中风的好处，许多不必要的手术将不得不进行。无症状患者的中风风险可以通过其血流量储备来识别。首先，申请人需要确定确定受损储量的最准确方法。然后，Pindzola博士计划设计一项研究，根据脑血管储备测量来评估无症状患者中风的风险。

DESCRIPTION: (Adapted from applicant's abstract) Ronda Pindzola has a Ph.D. degree in Bio-Psychology and did her post doctoral fellowships at Ohio State University in anatomy and Case Western Reserve University in neuroscience. Since then she has moved into the field of clinical research and for the last four years has been working with Drs. Yonas and Nemoto on studies involving patients with SAH or carotid stenosis/occlusion. Her long term objectives involve the study of factors which influence the risk for stroke for the purpose of improving treatment therapies for patients with cerebrovascular disease. Although Dr. Pindzola has a solid background in research, she needs further training in aspects of research that are specific to clinical studies such as interpretation of diagnostic studies, epidemiology and statistics. Dr. Nemoto and Dr. Yonas are extremely well suited to function as her mentor and co-mentor due to their different backgrounds which culminated in clinical research of cerebrovascular disease. Dr. Pindzola also has a multidisciplinary team of investigators including neuroradiologists, neurosurgeons, vascular surgeons and an epidemiologist/statistician to help her recruit patients in addition to guidance in other aspects of the study. Several studies have shown that hemodynamic compromise and high risk for stroke can be identified by transcranial Doppler ultrasonography (TCD) and stable Xenon-enhanced computed tomography (Xe/CT) cerebral blood flow (CBF) measurements. The purpose of this study is to define the relationship between Xe/CT CBF and TCD and near infrared spectroscopy (NIRS) measurements in order to best identify the patients with compromised cerebrovascular reserves. The relationship of the degree of stenosis to cerebrovascular reserves will also be studied since cerebrovascular reserves may be more indicative of risk for stroke than degree of stenosis. The hypothesis is that the measurement of cerebrovascular reserves with Xe/CT CBF methods, will allow the investigators to best identify patients that have severely compromised reserves and thus are at greatest risk for subsequent stroke. Dr. Pindzola hopes to extend this study in the future to asymptomatic patients. Several recent studies have shown that patients with asymptomatic carotid stenosis benefit from carotid endarterectomy. However, the ACAS trial found that 17 patients needed to be operated on to prevent one stroke or death over five years. In order to derive this benefit of stroke prevention many unnecessary surgeries would have to be done. The asymptomatic patients who are at risk for stroke could be identified by their blood flow reserves. First the applicant needs to determine the most accurate method of determining compromised reserves. Then Dr. Pindzola plans to design a study to assess risk for stroke in asymptomatic patients based on cerebrovascular reserve measurements.