PRECISE (PeRfusion imaging to identify postErior CIrculation candidateS for thrombectomy)

项目总结。 急性缺血性中风是美国致残的主要原因，也是导致残疾的第二大原因 世界范围内的死亡。累及主要颈部或大脑动脉的人工血管闭塞称为大血管闭塞， 最近具有里程碑意义的随机研究发现，血管内血栓摘除术是一种有效的治疗方法 颈内动脉、大脑中动脉或大脑前动脉大血管闭塞引起的缺血性卒中 (前循环)。然而，高达15%的大血管闭塞发生在椎动脉或基底动脉， 这些后循环中风患者在很大程度上被排除在现代血管内血栓切除术之外 审判。椎动脉或基底动脉闭塞患者的临床结果往往很差，严重 致残或死亡分别占患者的30-54%和36-86%。没有预期的或 旨在确定应该使用哪种成像策略来指导血栓切除术的随机数据 在这个研究不足的人群中做出治疗决定。 PRECIST(用于确定后循环候选血栓切除术的灌注成像)是一种有前景的 24小时内椎动脉或基底动脉闭塞所致急性缺血性卒中患者的队列研究 症状出现的小时数。患者在血管内治疗前将接受CT或MRI脑血流灌注成像 血栓切除治疗。这项研究的结果将确定脑灌注成像是否可以识别 最有可能在血栓摘除治疗后获得良好结果的患者亚组。精确 有可能改善急性后部缺血性卒中患者的影像评估 为这些患者的血栓清除疗效提供有价值的预后信息，以及 确定可能从未来的神经保护策略中受益的患者亚群。

PROJECT SUMMARY . Acute ischemic stroke is the leading cause of disability in the United States and the second-leading cause of death worldwide. AIS that involves a major cervical or cerebral artery is termed a large vessel occlusion, and recent landmark randomized studies found that endovascular thrombectomy is an effective treatment for ischemic stroke caused by large vessel occlusion of the internal carotid, middle, or anterior cerebral arteries (anterior circulation). However, up to 15% of large vessel occlusions occur in the vertebral or basilar arteries, and these posterior circulation stroke patients were largely excluded from modern endovascular thrombectomy trials. Clinical outcomes in patients with vertebral or basilar artery occlusions are often poor with severe disability or death occurring in 30-54% and 36-86% of patients, respectively. There are no prospective or randomized data designed to determine which imaging strategies should be used to guide thrombectomy treatment decisions in this understudied population. PRECISE (PeRfusion imaging to identify postErior CIrculation candidateS for thrombEctomy) is a prospective cohort study of patients with acute ischemic stroke due to occlusion of the vertebral or basilar artery within 24- hours of symptom onset. Patients will undergo CT or MRI cerebral perfusion imaging prior to endovascular thrombectomy treatment. The results of this study will determine if cerebral perfusion imaging can identify a subset of patients who are most likely to have a favorable outcome after thrombectomy treatment. PRECISE has the potential to improve the imaging evaluation of patients with acute ischemic stroke of the posterior circulation, to provide valuable prognostic information regarding thrombectomy efficacy in these patients, and to define sub-groups of patients who might benefit from future neuroprotective strategies.