MRI Detection of CarotId Plaques as a mecHanism for Embolic strokes of undeteRmined source (MRI DECIPHER)

颈动脉斑块的 MRI 检测作为不明原因栓塞性中风的机制（MRI DECIPHER）

• 批准号: 10204095
• 负责人: Ajay Gupta
• 金额: $ 82.36万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10204095
• 关键词: Acute; Anatomy; Arterial Fatty Streak; Arteries; Atrial Fibrillation; Blood Vessels; Blood flow; Brain; Brain Infarction; Brain natriuretic peptide; Cardiac; Carotid Arteries; Carotid Artery Plaques; Carotid Endarterectomy; Cerebrovascular Circulation; Clinical; Clinical Trials; Coagulation Process; Contralateral; Data; Detection; Dilatation - action; Disease; Echocardiography; Embolism; Enrollment; Etiology; Evaluation; Event; Face; Fostering; Foundations; Heart Atrium; Hemorrhage; Hospitals; Image; Incidence; Infarction; Inflammation; Inpatients; Internal carotid artery structure; Ipsilateral; Ischemic Stroke; Lead; Left; Link; Magnetic Resonance Imaging; Medical; Mission; Monitor; Multicenter Trials; National Heart, Lung, and Blood Institute; Neurologist; Observational Study; Patients; Physiological; Pilot Projects; Positron-Emission Tomography; Prevention; Preventive therapy; Procedures; Protocols documentation; Public Health; Recurrence; Research; Risk; Risk Factors; Risk Marker; Rupture; Side; Source; Standardization; Stenosis; Stents; Stroke; Stroke prevention; Structure; Suggestion; Testing; Therapeutic; Transcranial Doppler Ultrasonography; Travel; Validation; Vascular Diseases; adjudicate; clinical practice; cryptogenic stroke; embolic stroke; heart rhythm; high risk; imaging detection; imaging study; improved; indexing; insight; novel; personalized medicine; prospective; randomized trial; screening; stroke patient; stroke risk; uptake; vascular risk factor

PROJECT SUMMARY/ABSTRACT In one-third of strokes, a definite cause cannot be established. This proposal seeks to determine if some of these strokes in fact resulted from unrecognized atherosclerotic plaque in the arteries leading to the brain. Currently, only atherosclerotic plaques that cause significant stenosis (narrowing) of an artery are treated as the underlying cause of a stroke. However, pilot data suggest that nonstenosing plaques—plaques that have not caused arterial narrowing—can rupture and produce clots that travel downstream to block blood flow to the brain. Magnetic resonance imaging (MRI) can reliably determine which plaques have the highest risk of rupture. Such markers can identify high-risk nonstenosing plaques in the internal carotid arteries, which supply the majority of the brain's blood flow. In a patient with a stroke of unknown cause, pilot studies have found that the stroke is more likely to have occurred on the side of a carotid artery with high-risk nonstenosing plaque than on the opposite side where no high-risk plaque is present. The tendency of strokes to occur downstream of a high-risk nonstenosing plaque supports this application's hypothesis: that atherosclerotic plaque in the cerebral circulation is associated with stroke even in the absence of significant arterial narrowing. Such nonstenosing plaques may explain a substantial proportion of strokes whose cause currently seems unknown. Better recognition of these plaques may lead to better stroke prevention. Prior clinical trials found that carotid endarterectomy/stenting was not effective for preventing stroke recurrence in patients with nonstenosing plaque, and such plaques are now ignored in clinical practice. However, no trial has tested carotid endarterectomy/stenting in only those stroke patients whose nonstenosing plaque entails a stroke recurrence risk high enough that the benefits of the procedure outweigh its risks. If successful, the research proposed in this application would identify a novel stroke risk factor and establish the scientific premise for a potentially transformative therapeutic strategy. This application is for a prospective observational study of 200 patients with stroke of unknown cause. A detailed MRI protocol will be used to detect intraplaque hemorrhage, a marker of high-risk nonstenosing plaque. In 150 of the subjects, a PET/MRI study will also be performed for additional insight into high-risk features such as plaque inflammation. Aim 1 will test the hypothesis that brain infarcts will be more common on the side of a high-risk nonstenosing plaque than the opposite side. Aim 2 will test the hypothesis that in-depth stroke evaluation will less often uncover an alternative explanation in subjects with high-risk nonstenosing plaque than in those without such plaques. Aim 3 will test the hypothesis that recurrent infarction will occur more often on the same side as high-risk nonstenosing plaque than on the opposite side. Validation of these hypotheses would set the stage for a multicenter, randomized trial of carotid endarterectomy/stenting in patients with cryptogenic stroke and ipsilateral high-risk nonstenosing plaque.

项目摘要/摘要 在三分之一的笔触中，无法确定定义的原因。该建议旨在确定是否 实际上，其中一些中风是由于动脉中未被认可的动脉粥样硬化斑块而引起的 脑。目前，仅引起动脉狭窄（狭窄）的动脉粥样硬化斑块是 被视为中风的根本原因。但是，飞行员数据表明​​斑块 - 斑块 尚未引起动脉狭窄的情况 - 会破裂并产生下游传播以阻止血液的布料 流向大脑。磁共振成像（MRI）可以可靠地确定哪些斑块具有最高 破裂的风险。这样的标记可以在内部颈动脉中识别高风险的非延伸斑块，这是 提供大脑的大部分血液流动。在患有未知原因的患者中，试验研究 发现中风更可能发生在颈动脉的一侧 斑块比不存在高风险牌匾的另一侧。中风的趋势发生 高风险非稳定斑块的下游支持该应用的假设：动脉粥样硬化 即使没有明显的动脉狭窄，大脑循环中的斑块也与中风有关。 这种不踩踏的斑块可能会解释很大一部分的中风 未知。更好地识别这些斑块可能会导致预防中风更好。先前发现的临床试验 颈动脉内膜切除术/支架对防止患者的中风复发无效 现在，在临床实践中忽略了非稳定斑块和此类斑块。但是，没有试验 颈动脉内膜切除术/仅在那些卒中患者中，其无稳定斑块需要中风 复发的风险足够高，以至于程序的好处大于其风险。如果成功，研究 在本应用中提出的建议将确定一个新型的中风风险因素，并确定一个科学前提 潜在的变革理论策略。该应用是针对200个前瞻性观察研究 病因不明的患者。详细的MRI方案将用于检测内部出血， 高风险非稳定牌匾的标记。在150个受试者中，还将进行宠物/MRI研究 对高风险特征（例如牙菌斑注射）的额外洞察力。 AIM 1将检验大脑的假设 与对方相比，在高风险非稳定牌匾的一侧，Infacts更为普遍。 AIM 2意志 检验以下假设，即深入中风评估将较少发现对受试者的替代解释 与没有这种斑块的高风险无稳定斑块相比。 AIM 3将检验以下假设 复发性梗塞将与高风险非稳定牌匾更频繁地发生在同一侧 对面。这些假设的验证将为颈动脉的多中心随机试验奠定基础 隐性中风和同侧高风险非稳定斑块的患者的内膜切除术/支架。