Noninvasive monitoring of cerebrovascular autoregulation during and after endovascular therapy for acute ischemic stroke

急性缺血性卒中血管内治疗期间和之后脑血管自动调节的无创监测

• 批准号: 10668021
• 负责人: Maxim Mokin
• 金额: $ 21.83万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10668021
• 关键词: Acute; Address; Affect; Angiography; Biological Markers; Blood Pressure; Blood flow; Brain; Brain Edema; Brain Injuries; Caring; Catheters; Cause of Death; Cephalic; Cerebral Infarction; Cerebral cortex; Cerebral hemisphere hemorrhage; Cerebrovascular Circulation; Cerebrovascular Physiology; Cerebrum; Classification; Clinical; Coagulation Process; Complication; Diagnosis; Diffuse; Disease; Distal; Favorable Clinical Outcome; Goals; Head; Health; Hemorrhage; Homeostasis; Hour; Human; Image; Imaging Device; Imaging technology; Impairment; Infarction; Injury; Ischemia; Ischemic Stroke; Knowledge; Length; Malignant - descriptor; Measurement; Measures; Modeling; Monitor; Morbidity - disease rate; Near-Infrared Spectroscopy; Neurologist; Optical Instrument; Optics; Outcome; Patient-Focused Outcomes; Patients; Perfusion; Phase; Physicians; Physiological; Procedures; Recovery; Regression Analysis; Regulation; Reperfusion Injury; Reperfusion Therapy; Research; Scheme; Severities; Spectrum Analysis; Technology; Time; Tissues; Treatment outcome; Vascularization; blood flow measurement; cerebral artery; cerebrovascular; clinical application; clinical imaging; cohort; computerized data processing; disability; efficacy evaluation; endovascular thrombectomy; hemodynamics; imaging modality; improved; individual patient; innovation; instrument; ischemic injury; mortality; non-invasive monitor; personalized care; personalized medicine; precision medicine; predict clinical outcome; prevent; radiological imaging; response; standard of care; stroke recovery; temporal measurement; thrombolysis; tool; treatment optimization

PROJECT SUMMARY/ABSTRACT Ischemic stroke is a debilitating disease that is the leading cause of long-term disability in the US despite the prevalent use of clinical imaging technologies to identify, diagnose and classify brain injuries. Care and management of acute ischemic strokes (AIS) due to large vessel occlusion (LVO) (~200,000 cases/year) is based on endovascular thrombectomy (ET), which improves cerebral blood flow by removing blockage in distal cerebral arteries. Despite the promise and widespread use of ET, about a third of patients with technically successful ET procedures develop reperfusion injuries with high degrees of morbidity and mortality, often identified only after-the-fact by standard of care imaging. Indeed, real-time optimization/personalization of treatment is currently not feasible, because we lack robust technologies that can directly measure CBF or characterize changes in cerebrovascular function at the bedside. The primary goal of this proposal is to address this informational gap in bedside monitoring, through a robust noninvasive optical instrument and data processing scheme. This research will deploy a new noninvasive Diffuse Correlation Spectroscopy (DCS) instrument for fast, depth-sensitive measurement of cerebral blood flow in patients with AIS from LVO. The new instrument will be used to derive high-fidelity, quantitative measurements of pulsatile cerebral blood flow from deep cortical microvasculature, during ET therapy. Quantitative measurements of CBF with DCS will be used to grade/quantify cerebral tissue reperfusion during acute therapy for AIS from LVO. Leveraging the enhanced capabilities of the new instrument, this proposal will utilize measurements of steady-state fluctuations in cortical cerebral blood flow and arterial blood pressure to quantify cerebrovascular autoregulation (CVAR). CVAR is a functional biomarker of cerebrovascular tissue health and is predictive of injury severity and stroke recovery. In the same cohort of patients with AIS with LVO, the new DCS instrument will be used to estimate and track changes in CVAR at the patient’s bedside over the first 24 hours after ET, when reperfusion injuries are thought to occur. Longitudinal measurements of CVAR will be correlated with radiographical assessments of the brain at 24 hours post-ET, to evaluate if CVAR changes are predictive of reperfusion injuries. Clinical application of the innovative strategies proposed here will lead to transformative breakthroughs in bedside monitoring of ischemic stroke by providing neurologists with vital real-time physiological information about cerebrovascular function, paving the way for personalized treatments, precision medicine and improved patient outcomes.

项目总结/摘要 缺血性中风是一种使人衰弱的疾病，是美国长期残疾的主要原因， 临床成像技术的普遍使用，以识别，诊断和分类脑损伤。护理和 大血管闭塞（LVO）导致的急性缺血性卒中（AIS）的管理（约200，000例/年）是 基于血管内血栓切除术（ET），通过清除远端阻塞改善脑血流 脑动脉尽管ET的前景和广泛使用，大约三分之一的患者在技术上 成功的ET手术会产生具有高发病率和死亡率的再灌注损伤， 仅在事后通过标准护理成像来识别。事实上，实时优化/个性化 治疗目前是不可行的，因为我们缺乏强大的技术，可以直接测量CBF或 在床旁表征脑血管功能的变化。该提案的主要目标是解决 床旁监护中的信息缺口，通过强大的非侵入性光学仪器和数据 加工方案这项研究将部署一种新的非侵入性扩散相关光谱（DCS） 一种用于快速、深度敏感地测量AIS患者LVO脑血流量的仪器。新 仪器将被用来获得高保真度，定量测量脉动脑血流从 深层皮质微血管。将使用DCS定量测量CBF， 对LVO AIS急性治疗期间的脑组织再灌注进行分级/量化。利用增强的 新仪器的能力，这项建议将利用皮质稳态波动的测量， 脑血流量和动脉血压来量化脑血管自动调节（CVAR）。CVAR是一个 脑血管组织健康的功能生物标志物，并预测损伤严重程度和中风恢复。在 对于患有AIS伴LVO的同一队列患者，将使用新的DCS仪器估计和跟踪 ET后前24小时内患者床边CVAR的变化，此时认为再灌注损伤 发生。CVAR的纵向测量将与大脑的放射学评估相关， ET后24小时，以评估CVAR变化是否预测再灌注损伤。的临床应用 本文提出的创新策略将导致缺血性心脏病床边监测的变革性突破。 通过为神经科医生提供有关脑血管功能的重要实时生理信息， 为个性化治疗、精准医疗和改善患者预后铺平道路。