Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke

椎基底动脉血流评估以及短暂性脑缺血发作和中风的风险

• 批准号: 8288237
• 负责人: Sepideh Amin-Hanjani
• 金额: $ 40.44万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-01 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8288237
• 关键词: Adult; Algorithms; Angioplasty; Blinded; Blood Circulation; Blood flow; Cause of Death; Cerebrum; Clinical; Clinical Trials; Cohort Studies; Data; Disease; Disease Management; Distal; Enrollment; Epidemiology; Etiology; Evaluation; Event; Functional disorder; Future; Goals; Health Care Costs; Image; Individual; Intervention; Laboratories; Logistics; Longitudinal Studies; Magnetic Resonance Angiography; Measurement; Measures; Medical; Methods; Modeling; Monitor; Observational Study; Operative Surgical Procedures; Patients; Perfusion; Physicians; Population; Predictive Factor; Public Health; Recruitment Activity; Recurrence; Risk; Screening procedure; Selection Criteria; Site; Stenosis; Stroke; Survival Analysis; Testing; Time; Tissues; Transient Ischemic Attack; abstracting; base; cost; disability; follow-up; hazard; hemodynamics; high risk; patient population; prospective; randomized trial; risk selection; success; tool

Project Summary/Abstract Over one third of the 700,000 strokes suffered annually occur in the posterior circulation, a major cause of which is atherosclerotic vertebrobasilar occlusive disease. Symptomatic vertebrobasilar disease carries a high annual stroke risk, averaging 10-15% per year. Advances in endovascular angioplasty and stenting have created new treatment options, but these interventions carry significant risks, and selection criteria for determining appropriate candidates remain uncertain. Prior to embarking on expensive large-scale randomized trials of intervention, it is necessary to define the appropriate high risk population most likely to benefit from treatment. The overall goal of this study is to define the population of patients with vertebrobasilar disease at highest risk of recurrent stroke. The results will be well poised to form the basis for future clinical trials of endovascular or surgical interventions. Preliminary retrospective data indicates that stroke risk in vertebrobasilar disease is strongly related to compromised intracranial blood flow, the extent of which can be measured noninvasively using quantitative magnetic resonance angiography (QMRA). The objective is to conduct a prospective multi-center observational study of patients with symptomatic angiographically confirmed vertebrobasilar stenosis (? 50%) or occlusion to test the hypothesis that those who demonstrate compromised blood flow are at higher stroke risk. Upon enrollment, subjects will undergo hemodynamic assessment with QMRA to assess large vessel flow, and MR perfusion to assess tissue level perfusion, in the vertebrobasilar territory. Subjects will be prospectively designated as demonstrating compromised or normal cerebral flow, based upon existing preliminary data; the results will be kept blinded from treating physicians and patients. Baseline clinical, laboratory, and epidemiological data will be systematically collected. Patients will be followed at monthly intervals for a minimum of 12 months for the primary endpoint of stroke in the vertebrobasilar territory. Project Narrative By defining the population of patients at highest risk of recurrent stroke, this study will significantly impact the selection criteria and likelihood for success of future clinical trials aimed at assessing interventions for the treatment of vertebrobasilar disease. Additionally, the ability to define a low risk population in whom the risks of expensive invasive interventions would be unnecessary will have an equally important impact from a public health, and health care cost, perspective.

项目总结/摘要 每年700，000例中风中有超过三分之一发生在后循环，这是中风的主要原因。 动脉粥样硬化性椎基底动脉闭塞性疾病。症状性椎基底动脉疾病携带高 年中风风险，平均每年10-15%。血管内成形术和支架植入术的进展 创造了新的治疗选择，但这些干预措施具有重大风险， 确定合适的候选人仍然不确定。在开始进行昂贵的大规模随机 在干预试验中，有必要确定最有可能受益的适当高危人群。 治疗本研究的总体目标是确定年龄在20岁以下的椎基底动脉疾病患者人群， 中风复发的风险最高。这些结果将为未来的临床试验奠定基础。 血管内或外科手术干预。 初步的回顾性数据表明，椎基底动脉疾病的卒中风险与以下因素密切相关： 受损的颅内血流，其程度可以使用定量无创测量 磁共振血管造影（QMRA）。目的是进行一项前瞻性多中心观察性研究， 血管造影证实的症状性椎基底动脉狭窄（？50%）或闭塞至 检验血流受损的人中风风险更高的假设。后 入组时，受试者将接受QMRA血流动力学评估，以评估大血管血流和MR 灌注，以评估椎基底动脉区域中的组织水平灌注。受试者将前瞻性地 根据现有的初步数据，被指定为证明脑血流受损或正常; 治疗医生和患者将对结果保持盲态。基线临床、实验室和 将有系统地收集流行病学数据。患者将每月随访一次， 主要终点椎基底动脉区卒中至少12个月。项目叙述 通过确定复发性卒中风险最高的患者人群，本研究将显著影响 未来临床试验的选择标准和成功的可能性，旨在评估针对 椎基底动脉疾病的治疗。此外，定义低风险人群的能力， 昂贵的侵入性干预将是不必要的，将对公众产生同样重要的影响。 健康和医疗保健成本，前景。

项目成果

Effect of Hemodynamics on Stroke Risk in Symptomatic Atherosclerotic Vertebrobasilar Occlusive Disease.

血液动力学对有症状的动脉粥样硬化脊椎囊肿性疾病中卒中风险的影响。

• DOI: 10.1001/jamaneurol.2015.3772
• 发表时间: 2016-02
• 期刊: JAMA neurology
• 影响因子: 29
• 作者: Amin-Hanjani S;Pandey DK;Rose-Finnell L;Du X;Richardson D;Thulborn KR;Elkind MS;Zipfel GJ;Liebeskind DS;Silver FL;Kasner SE;Aletich VA;Caplan LR;Derdeyn CP;Gorelick PB;Charbel FT;Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke Study Group
• 通讯作者: Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke Study Group

Cost-Effectiveness of Quantitative Magnetic Resonance Angiography Screening and Submaximal Angioplasty for Symptomatic Vertebrobasilar Disease.

定量磁共振血管造影筛查和次最大血管成形术治疗症状性椎基底动脉疾病的成本效益。

• DOI: 10.1161/strokeaha.118.022339
• 发表时间: 2018
• 期刊: Stroke
• 影响因子: 8.3
• 作者: Esfahani,DarianR;Pandey,Dilip;Du,Xinjian;Rose-Finnell,Linda;Charbel,FadyT;Derdeyn,ColinP;Amin-Hanjani,Sepideh;VERiTASStudyGroup
• 通讯作者: VERiTASStudyGroup

Perfusion-MRI is a Poor Indicator of Hemodynamic Compromise in Vertebrobasilar Disease in the VERiTAS Study.

• DOI: 10.1111/jon.12802
• 发表时间: 2021-01
• 期刊: Journal of neuroimaging : official journal of the American Society of Neuroimaging
• 作者: See AP;Stapleton CJ;Du X;Charbel FT;Amin-Hanjani S;VERiTAS Study Group
• 通讯作者: VERiTAS Study Group

Optimized Hemodynamic Assessment to Predict Stroke Risk in Vertebrobasilar Disease: Analysis From the VERiTAS Study.

优化血流动力学评估以预测椎基底动脉疾病中风风险：VERiTAS 研究分析。

• DOI: 10.1161/jaha.120.016406
• 发表时间: 2020
• 期刊: Journal of the American Heart Association
• 影响因子: 5.4
• 作者: See,AlfredP;Pandey,DilipK;Du,Xinjian;Rose-Finnell,Linda;Charbel,FadyT;Derdeyn,ColinP;Amin-Hanjani,Sepideh;VERiTASStudyGroup*†
• 通讯作者: VERiTASStudyGroup*†

Vertebrobasilar Flow Evaluation and Risk of Transient Ischaemic Attack and Stroke study (VERiTAS): rationale and design.

• DOI: 10.1111/j.1747-4949.2010.00528.x
• 发表时间: 2010-12
• 期刊: International journal of stroke : official journal of the International Stroke Society
• 作者: Amin-Hanjani S;Rose-Finnell L;Richardson D;Ruland S;Pandey D;Thulborn KR;Liebeskind DS;Zipfel GJ;Elkind MS;Kramer J;Silver FL;Kasner SE;Caplan LR;Derdeyn CP;Gorelick PB;Charbel FT;VERiTAS Study Group
• 通讯作者: VERiTAS Study Group