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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）

基本信息

批准号：
10661676
负责人：
Ajay Gupta
金额：
$ 69.39万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
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/10661676
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 Cephalic Cerebrovascular Circulation Clinical Clinical Trials Coagulation Process Contralateral Data Detection Dilatation - action Disease Echocardiography Electrocardiogram 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 Testing Therapeutic Transcranial Doppler Ultrasonography Travel Validation Vascular Diseases adjudication clinical practice cryptogenic stroke embolic stroke heart rhythm high risk improved indexing insight novel personalized medicine prospective randomized trial screening stroke patient stroke risk uptake vascular risk factor

项目摘要

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.

项目总结/文摘