Serial Physiologic MRI in Minor Stroke with Large Vessel Occlusion

伴有大血管闭塞的小中风的系列生理 MRI

• 批准号: 10598577
• 负责人: JOHN A DETRE
• 金额: $ 20.31万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10598577
• 关键词: 3-Dimensional; Arteries; Blood Vessels; Blood flow; Brain; Caring; Catheters; Cerebrovascular Circulation; Characteristics; Clinical; Clinical Management; Clinical Trials; Coagulation Process; Data; Deterioration; Development; Diffusion; Diffusion Magnetic Resonance Imaging; Evolution; Excision; Exposure to; Functional Imaging; Future; Hour; Image; Infarction; Ischemic Penumbra; Ischemic Stroke; Knowledge; MRI Scans; Magnetic Resonance Imaging; Maps; Mechanics; Medicine; Metabolic; Metabolism; Methodology; Minor; Nature; Neurologic; Observational Study; Outcome; Oxygen; Patient Selection; Patient Triage; Patients; Perfusion; Phase; Physiological; Physiology; Play; Predictive Value; Protocols documentation; Research; Role; Scanning; Selection Bias; Serial Magnetic Resonance Imaging; Stroke; Symptoms; Testing; Thrombectomy; Time; Tissues; United States National Institutes of Health; X-Ray Computed Tomography; acute stroke; arterial spin labeling; clinical care; design; disability; early detection biomarkers; early experience; functional outcomes; hypoperfusion; improved; innovation; insight; novel; novel strategies; outcome prediction; patient population; patient stratification; perfusion imaging; predict clinical outcome; predictive marker; rate of change; stroke patient; stroke symptom; stroke therapy; tissue oxygenation

PROJECT SUMMARY Mechanical thrombectomy (MT) has revolutionized the treatment of stroke due to large vessel occlusion (LVO) in patients with moderate or severe stroke symptoms. However, clinical management remains controversial in LVO patients with relatively minor deficits because these patients were not well represented in the MT clinical trials. Up to one third of patients with LVO and minor deficits will experience early neurologic deterioration (END) which portends significant long-term disability. Observational studies, though conflicting and limited by selection bias, suggest that some of these patients may benefit from early MT, but it remains challenging to predict END and waiting for END to pursue MT has been associated with poor functional outcome. The development of predictive biomarkers for END represents a critical need for the optimization of MT therapy in patients with LVO and relatively mild clinical deficits. In moderate or severe stroke with LVO, contrast based perfusion imaging indicates the presence of an ischemic penumbra based on prolonged transit time, and has been crucial in optimizing patient selection and extending the time window for MT. However, the role of contrast based perfusion imaging is less clear in LVO patients with minor clinical deficits because prolonged transit time in this patient population does not reliably predict eventual infarction. Further, current imaging strategies are limited to a snapshot in time and thus fail to account for the dynamic nature of tissue physiology and function. END is a consequence of progressive loss of collateral blood flow supplying the ischemic penumbra, but the paucity of data on the early temporal evolution of the ischemic penumbra remains a key knowledge gap for predicting clinical outcomes such as END. This project will leverage the availability of research MRI within a new stroke and neurointensive care unit to characterize the temporal evolution of penumbral blood flow and oxygen metabolism in LVO patients with NIH stroke scale (NIHSS) < 6, within the first 24 hours of symptom onset. A unique aspect of this study will be the use of serial MRI scanning to quantify short-term changes in penumbral physiology. The scanning protocol will also leverage innovative MRI methodologies for noninvasively mapping cerebral blood flow and tissue oxygen extraction. We hypothesize that serial MRI will identify flow and metabolic deterioration in advance of clinical deterioration and with greater sensitivity than standard clinical single time point imaging. This exploratory R21 project will validate a novel imaging strategy, provide new insights into the evolution of the ischemic penumbra during the hyperacute phase of ischemic stroke, and provide critical data needed to design future studies using this approach to personalize clinical care of stroke patients with LVO and minor deficits.

项目总结 机械血栓切除术(MT)使大血管闭塞(LVO)所致卒中的治疗发生了革命性的变化 在有中度或重度中风症状的患者中。然而，临床管理在以下方面仍然存在争议 LVO患者有相对较小的缺陷，因为这些患者在MT临床中没有很好的代表性 审判。多达三分之一的左心室关闭不全和轻微缺陷的患者会经历早期的神经恶化(完) 这预示着严重的长期残疾。观察性研究，虽然相互冲突，但受到选择的限制 偏倚，表明其中一些患者可能从早期MT中受益，但预测结局仍然具有挑战性 等待结束进行MT与不良的功能结局有关。的发展。 END的预测性生物标志物是优化左心衰患者MT治疗的迫切需要 和相对轻微的临床缺陷。 在伴有LVO的中、重度卒中，基于对比剂的灌注成像提示存在缺血 半影区基于延长的传输时间，在优化患者选择和扩展方面一直至关重要 MT的时间窗口。然而，基于对比度的灌注成像在左冠状动脉狭窄患者中的作用尚不清楚。 较小的临床缺陷，因为该患者群体中延长的转运时间不能可靠地预测最终 脑梗塞。此外，当前的成像策略仅限于时间上的快照，因此不能考虑 组织生理和功能的动态性质。末梢是络脉逐渐失血的结果 血流供应缺血半暗带，但缺乏关于缺血区早期时间演变的数据 半暗带仍然是预测END等临床结果的关键知识缺口。 该项目将利用新的中风和神经重症监护病房中研究MRI的可用性来 NIH患者LVO患者半暗带血流和氧代谢的时间演变特征 中风评定量表(NIHSS)&lt；6，在症状出现的前24小时内。这项研究的一个独特方面将是 使用序列MRI扫描来量化半影区生理的短期变化。扫描协议将 还利用创新的MRI方法无创地绘制脑血流量和组织氧含量图 拔牙。我们假设序列核磁共振将在临床之前发现血流和代谢的恶化。 比标准的临床单时间点成像具有更高的灵敏度。这款探索性的R21 该项目将验证一种新的成像策略，为缺血性半影区的演变提供新的见解 在缺血性中风的超急性期，并提供设计未来研究所需的关键数据 这一方法为有LVO和轻微缺陷的中风患者提供了个性化的临床护理。

项目成果

Microvascular reperfusion during endovascular therapy: the balance of supply and demand.

血管内治疗期间的微血管再灌注：供需平衡。

• DOI: 10.1136/jnis-2023-020834
• 发表时间: 2023
• 期刊: Journal of neurointerventional surgery
• 影响因子: 4.8
• 作者: Favilla,ChristopherG;Forti,RodrigoM;Carter,Sarah;Kofke,WAndrew;Kasner,ScottE;Baker,WesleyB;Yodh,ArjunG;Messé,StevenR;Cummings,Stephanie;Kung,DavidK;Burkhardt,JanKarl;Choudhri,OmarA;Pukenas,Bryan;Srinivasan,VisishM;Hu
• 通讯作者: Hu