Diffuse Optics for Acute Stroke Management

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DESCRIPTION (provided by applicant): This Bioengineering Research Partnership (BRP) couples biomedical scientists & clinicians with expertise in cerebrovascular physiology and human stroke with biophysical scientists & engineers with expertise in optics, electronics, mathematics and computation. These partners will develop and validate a novel optical instrument for bedside monitoring of cerebral blood flow (CBF) and associated hemodynamics in acute stroke patients. Ischemic stroke is the leading cause of disability and a leading cause of mortality in the US today, affecting approximately 700,000 people annually with a projected cost of over $400 billion per decade. One of the major treatment challenges is the relative inaccessibility of brain tissue to physiological monitoring. Imaging modalities such as CT, MRI, and PET scanning require large and costly instrumentation that severely limit their use during patient hospitalization. Thus stroke interventions, intended to increase blood flow in and around the stroke region, are usually prescribed empirically or in response to clinical deterioration. Diffuse optics holds potential to dramatically change patient care by providing technology to measure CBF and associated hemodynamics continuously at the bedside, thereby permitting management interventions to be optimized and individualized for each patient based on tissue response. Preliminary data acquired in animal models and human subjects demonstrate the feasibility of this approach. Four research groups at the University of Pennsylvania will partner to further develop and validate this approach in the clinic. The Biomedical Optics Group led by P.I. Arjun Yodh will assume a central role participating in and coordinating project activities. Device development will be carried out in collaboration with the Electronic Instrumentation Group, led by Richard Van Berg. Validation in animal models will be carried out in collaboration with the Animal Studies Group, led by Joel Greenberg. Validation against MRI and SPECT blood flow measures in normal volunteers and in patients with acute stroke will be carried out in collaboration with the Clinical Studies Group, led by John Detre. Animal and human data will be used to guide refinements in instrument design and signal processing, and to develop sample size estimates for future clinical trials that will definitively demonstrate the efficacy of bedside CBF monitoring in stroke care. Technology commercialization and dissemination will be facilitated by Michael Cleare, Director of the Center for Technology Transfer. Diffuse Optics for Acute Stroke Management. PUBLIC HEALTH RELEVANCE: Ischemic stroke is the leading cause of disability and a leading cause of mortality in the United States today. There is no technique for monitoring blood flow in the brain of stroke victims in the hours and days following their stroke. The goal of this project is to develop and validate an instrument for monitoring blood flow and oxygenation in the brain of acute stroke patients at the bedside prior to the onset of new symptoms so as to facilitate their clinical management.