CEREBROVASCULAR RESERVE BY XE/CT VERSUS TCD AND OXIMETRY

描述：(根据申请者的摘要改编)Ronda Pindzola拥有生物心理学博士学位，并在俄亥俄州立大学解剖学和凯斯西储大学神经科学方面获得博士后奖学金。从那时起，她进入了临床研究领域，在过去的四年里，她一直与Yonas博士和Nemoto博士合作进行涉及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。尽管平佐拉博士在研究方面有扎实的背景，但她需要在专门针对临床研究的研究方面进行进一步的培训，如对诊断研究的解释、流行病学和统计学。Nemoto博士和Yonas博士非常适合担任她的导师和共同导师，因为他们的不同背景最终导致了脑血管疾病的临床研究。除了这项研究的其他方面的指导外，品佐拉还有一个由神经放射科医生、神经外科医生、血管外科医生和一名流行病学家/统计学家组成的多学科研究团队，帮助她招募病人。一些研究表明，通过经颅多普勒超声(TCD)和稳定的氙气增强计算机体层摄影(Xe/CT)脑血流量(CBF)测量可以识别血流动力学受损和卒中的高风险。本研究的目的是明确Xe/CT、CBF和TCD与近红外光谱(NIRS)测量的关系，以便最好地识别脑血管储备受损的患者。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，使用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，从而面临随后中风的最大风险。平佐拉博士希望在未来将这项研究扩展到没有症状的患者。最近的几项研究表明，无症状颈动脉狭窄的患者从颈动脉内膜切除术中受益。然而，ACAS的试验发现，需要对17名患者进行手术，以在五年内防止一次中风或死亡。为了获得这种预防中风的好处，必须进行许多不必要的手术。有中风风险的无症状患者可以通过他们的血流储备来识别。首先，申请人需要确定确定折衷储量的最准确方法。然后，平佐拉博士计划设计一项研究，以脑血管储备测量为基础，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.