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

项目摘要 中风是美国残疾的头号原因，也是一个全球性的公共卫生问题。在全球范围内， 每年约有1500万人患中风，导致500万人死亡，另有500万人死于中风。 中风导致永久性残疾的患者。中风是由大量血液阻塞引起的 向大脑供血的血管通常是最具致残性的。在过去的五年里， 这是这类中风的急性中风治疗的重大突破。2015年，多项试验表明， 血管内卒中治疗对存在以下情况的大血管缺血性卒中患者的显著受益 在早期时间窗内（症状发作后6小时内）。这一成功之后是DEFUSE 3 和DAWN试验显示，在延迟时间窗内，血管内治疗具有非常强的获益（6-24 症状发作后2小时）。这些疗法现已成为专科医院的标准治疗方法 （综合中风中心）在全国各地。尽管这种新的高效疗法，中风相关的 残疾仍然是大血管闭塞患者的主要问题，因为脑损伤， 发生在患者接受恢复脑血流的血管内治疗之前的时间段内。的 血流恢复之前的时间段可能很长（几个小时），特别是当患者需要转移时 从没有能力提供血管内治疗的社区医院到全面的 中风中心，做。由于这种延迟，在病人从手术室出来的时候到手术结束的时候之间， 最初出现在医院和恢复血流的时间。为了解决这个问题，我们需要 进行临床试验，在血流恢复前的关键时期保护大脑。 为了进行这样的试验，我们首先需要工具来识别最有可能受益于 保护大脑的治疗方法和可用于确定治疗是否有效的工具。的 该项目的总体目标是开发这些工具。我们将利用现有的成像技术 数据集和使用我们将从社区医院转移的患者那里获得的新数据 血管内治疗的综合中风中心确定可能受益于 为了保护大脑的治疗，我们将开发一种基于CT的工具， 患者在运输过程中可能会受到影响。为了能够确定治疗是否有效地保护 我们将开发一种基于CT的工具，可以准确测量脑损伤的数量（梗死体积） 在运输之前就已经存在。

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.