CTP to predict Response to recanalization in Ischemic Stroke Project (CRISP)

项目摘要 中风是美国残疾的头号原因。为了减轻残疾人的负担 因此需要更好的中风治疗，使更多的中风患者能够得到治疗。 血管内治疗正越来越多地被使用，并且可以满足这种需求，因为它们具有高的并发症发生率。 再通然而，尚不清楚哪些患者在临床上受益。 以往的研究表明，脑卒中患者有少量不可逆的缺血性损伤（梗死）， 核心）和大量可逆性缺血性损伤（半影）最有可能受益于恢复 血流MRI显示出识别缺血核心和半暗带的前景，但它具有非常有限的 美国急诊室的可用性。计算机断层扫描灌注（CTP）成像是一种潜在的解决方案， 它是广泛可用的，可以很容易地添加到一个非造影剂头部CT，已经常规获得评估 急诊室里的中风病人然而，用于处理CTP图像的方法和用于处理CTP图像的标准是不确定的。 对图像的解释还不成熟。因此，基于CTP图像的患者选择尚未就绪 用于在临床试验或临床实践中实施。 CTP预测缺血性卒中再通反应项目（CRISP）的总体目标是 开发一种实用的工具来识别可能从血管内治疗中受益的急性卒中患者。 该项目有两个主要部分。在第一部分（第一年），我们建议开发一个完全自动化的 用于处理CT灌注（CTP）图像的系统（RAPID），该系统将生成缺血性脑血管病的脑图。 核心和半影。我们还将根据这些CTP图定义标准，预测患者是否可能 从血流恢复中获益这些标准将基于95例回顾性队列的数据。 在圣卢克医院接受治疗的病人 在第二部分（2-5年），我们的目标是证明，医生在紧急情况下， 在全自动CTP分析程序（RAPID）辅助下，可以准确预测再通反应 中风患者进行血管重建。为了实现这一目标，我们将进行一项前瞻性队列研究 在血管内治疗前将接受CTP扫描的100名连续卒中患者。这项研究将 在两个研究中心（斯坦福大学和圣卢克医院）进行。患者将接受早期随访 在6小时内扫描以评估再灌注，并在第5天进行后期随访扫描以确定最终梗死。 这项研究的成功执行将为医生提供一种简单的自动化方法来选择 可能从恢复血流中受益的患者。这种方法，由于易于访问， CT技术在多中心急性脑卒中临床试验中对患者的选择具有重要价值， 最终，在常规临床实践中。

Project Summary Stroke is the number one cause of disability in the United States. In order to reduce the burden of disability caused by stroke there is a need for better stroke treatments that are available to more stroke victims. Endovascular therapies are increasingly being used and may fill this need as they have high rates of recanalization. It is, however, not known which patients benefit clinically. Previous studies suggest that stroke patients with a small volume of irreversible ischemic injury (infarct core) and a large volume of reversible ischemic injury (penumbra) are most likely to benefit from restoration of blood flow. MRI shows promise for identification of the ischemic core and penumbra but it has very limited availability in US emergency rooms. Computed Tomography Perfusion (CTP) imaging is a potential solution as it is widely available and can easily be added to a non-contrast head CT, already routinely obtained to evaluate stroke patients in the emergency room. However, methods for processing of CTP images and criteria for interpretation of the images are still immature. Therefore, patient selection based on CTP images is not ready for implementation in clinical trials or clinical practice. The overall goal of the CTP to predict Response to recanalization in Ischemic Stroke Project (CRISP) is to develop a practical tool to identify acute stroke patients who are likely to benefit from endovascular therapy. The project has two main parts. During the first part (year 1), we propose to develop a fully automated system (RAPID) for processing of CT Perfusion (CTP) images that will generate brain maps of the ischemic core and penumbra. We will also define criteria, based on these CTP maps, which predict if a patient is likely to benefit from restoration of blood flow. These criteria will be based on data from a retrospective cohort of 95 patients treated at St Luke's hospital. During the second part (years 2-5), we aim to demonstrate that physicians in the emergency setting, with the aid of a fully automated CTP analysis program (RAPID), can accurately predict response to recanalization in stroke patients undergoing revascularization. To achieve this aim we will conduct a prospective cohort study of 100 consecutive stroke patients who will undergo a CTP scan prior to endovascular therapy. The study will be conducted at two sites (Stanford University and St Luke's Hospital). Patients will have an early follow-up scan within 6 hours to assess reperfusion and a late follow-up scan at day 5 to determine the final infarct. The successful execution of this research will provide physicians with an easy, automated method to select patients who are likely to benefit from restoration of blood flow. Such a method, thanks to easy accessibility to CT technology, would be of great value for patient selection in multi-center clinical acute stroke trials and, eventually, in routine clinical practice.