CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project 2 (CRISP 2)

项目摘要 中风是美国头号残疾原因，也是全球公共卫生问题。在全球范围内， 每年约有1500万人中风，导致500万人死亡，另有500万人死亡。 因中风而遭受永久性残疾的患者。由大量血液阻塞引起的中风 向大脑供应血液的血管通常是最不起作用的。在过去的5年里，有 该类型卒中的急性卒中治疗取得重大突破。2015年，多项试验证明 血管内治疗对出现大血管缺血性卒中患者的深远好处 在早期时间窗内(症状出现后6小时内)。紧随其后的是《融合3》 曙光试验显示，在延迟的时间窗口(6-24)内血管内治疗具有非常强的益处 症状出现后数小时)。这些疗法现在已经成为专科医院的标准护理。 (综合中风中心)在全国各地。尽管这种新的高效疗法，与中风相关的 对于大血管闭塞的患者来说，残疾仍然是实质性的，因为 发生在患者接受血管内治疗之前的一段时间内，血管内治疗使血液恢复到大脑中。这个 血流恢复前的时间可能会很长(几个小时)，特别是当病人需要转移的时候 从一家没有能力提供血管内治疗的社区医院到全面的 中风中心就是这样。由于这一延迟，在患者 最初呈现给医院的是血液流动恢复的时间。要解决这个问题，我们需要 对在血流恢复前的关键时期保护大脑的疗法进行临床试验。 为了进行这样的试验，我们首先需要工具来确定哪些患者最有可能受益于 保护大脑的治疗，以及可以用来确定治疗是否有效的工具。这个 该项目的总体目标是开发这些工具。我们将使用现有的映像来实现这一目标 数据集，并使用我们将从社区医院转院的患者那里获得的新数据 去综合中风中心进行血管内治疗。确定哪些患者可能受益于 为了保护大脑，我们将开发一种基于CT的工具，可以直观地显示大脑损伤的程度 病人在运输过程中很可能会持续。能够确定一种治疗方法是否有效地保护 脑，我们将开发一种基于CT的工具，可以准确地测量脑损伤的数量(脑梗塞体积) 这在运输之前就已经存在了。

Project Summary Stroke is the number 1 cause of disability in the United States and a global public health problem. Globally, approximately 15 million people suffer a stroke each year, leading to 5 million deaths and another 5 million patients who suffer permanent disability from their stroke. Strokes that are caused by blockage of large blood vessels supplying blood to the brain are typically the most disabling. Over the last 5 years, there have been major breakthroughs in acute stroke therapy for this type of stroke. In 2015, multiple trials demonstrated a profound benefit from endovascular stroke therapy for patients with a large vessel ischemic stroke who present in the early time-window (within 6 hours after symptom onset). This success was followed by the DEFUSE 3 and DAWN trials showing a very strong benefit from endovascular therapy in the delayed time-window (6-24 hours after symptom onset). These therapies have now become standard of care at specialty hospitals (comprehensive stroke centers) across the country. Despite this new highly effective therapy, stroke-related disability continues to be substantial for patients with large-vessel occlusions, because of brain damage that occurs in the time-period before patients receive endovascular therapy that restores blood flow to the brain. The time period before blood flow is restored can be long (several hours) especially if patients need to be transferred from a community hospital that does not have the capability to provide endovascular therapy to a comprehensive stroke center that does. Because of this delay, significant brain damage can occur between the time that a patient initially presents to a hospital and the time that blood flow is restored. To address this problem, we need to conduct clinical trials of therapies that protect the brain in the crucial time-period before blood flow is restored. In order to conduct such trials, we first need tools to identify patients who are most likely to benefit from treatments that protect the brain and tools that can be used to determine if the treatments are effective. The overall aim of this project is to develop these tools. We will achieve this aim using both an existing imaging dataset and using new data that we will obtain from patients who are being transferred from a community hospital to a comprehensive stroke center for endovascular therapy. To identify patients who will likely benefit from treatments that protect the brain, we will develop a CT-based tool that visualizes how much brain damage a patient is likely to sustain during transport. To be able to determine if a treatment is effective at protecting the brain, we will develop a CT-based tool that can accurately measure the amount of brain damage (infarct volume) that is already present prior to transport.