Mechanisms of Stroke in Intracranial Stenosis and Stenting(MoSISS)

颅内狭窄和支架置入中风的机制（MoSISS）

• 批准号: 7868992
• 负责人: JOSE G ROMANO
• 金额: $ 39.1万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-15 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7868992
• 关键词: Address; Affect; Ancillary Study; Angiography; Arteries; Blood Vessels; Blood flow; Brain; Cerebral Infarction; Cerebrum; Characteristics; Circle of Willis; Development; Disease; Distal; Embolism; Enrollment; Event; Funding; Guidelines; Image; Image Analysis; Individual; Infarction; Intervention; Intracranial Atheroscleroses; Ipsilateral; Ischemia; Ischemic Stroke; Knowledge; Lead; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Measures; Medical; Monitor; Outcome; Parents; Patients; Process; Randomized; Recurrence; Risk; Role; Sampling; Signal Transduction; Stenosis; Stents; Stroke; Testing; Therapeutic Embolization; Time; Ultrasonography; United States; United States National Institutes of Health; Vasomotor; arm; artery stenosis; cerebrovascular; cohort; cost; exhaust; follow-up; hemodynamics; high risk; imaging modality; innovation; intracranial artery; middle cerebral artery; novel therapeutics; prevent; prospective; public health relevance; restenosis; therapeutic target; thrombolysis

DESCRIPTION (provided by applicant): Mechanisms of Stroke in Intracranial Stenosis and Stenting (MoSISS) This proposal is a prospective multi-center ancillary study to SAMMPRIS, an ongoing NIH- funded trial that evaluates intracranial stenting plus intensive medical therapy versus intensive medical therapy alone for recently symptomatic high-grade intracranial stenosis. The objective of this application is to understand the mechanisms that underlie ischemic stroke in stented and non-stented patients, as mechanistic aspects and related imaging analyses are not incorporated in SAMMPRIS. The results of this proposal will help define the appropriate parameters that predict stroke risk and may lead to novel therapeutics to address specific mechanisms of stroke. Our primary hypothesis is that several mechanisms underlie ischemic infarction in intracranial atherosclerosis. This proposal will evaluate 6 specific mechanisms of stroke in a sample of the SAMMPRIS cohort: decreased antegrade flow, progression of stenosis, decreased proximal collateral flow, decreased distal collateral flow, impaired cerebrovascular reserve, and artery-artery embolism. The main outcome will be ischemic stroke occurrence in the territory of the symptomatic artery, a principal endpoint in the SAMMPRIS study. A total of 100 medically-treated and 50 stented patients enrolled in the SAMMPRIS study will be studied with 3 imaging modalities, including: a) conventional angiography performed prior to randomization in SAMMPRIS; b) baseline QMRA to assess volumetric flow rate as a marker of antegrade flow and proximal collateral flow; c) serial TCD to measure flow velocities at baseline, 4, 8, 12 and 24 months, and at the time of ischemic stroke occurrence; d) baseline TCD to detect embolic signals in patients with intracranial carotid or middle cerebral artery stenosis; and e) baseline TCD with breath-holding to assess vasomotor reactivity in patients with intracranial carotid or middle cerebral artery stenosis. PUBLIC HEALTH RELEVANCE: Lay Summary: Mechanisms of Stroke in Intracranial Stenosis and Stenting (MoSISS) MoSISS is an ancillary study to the ongoing Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) study. Narrowing of the brain arteries due to plaque formation (intracranial atherosclerotic disease) is a common cause of stroke. The risk of stroke recurrence is significant, particularly in those with greater than 70% narrowing, even with medical therapy. Because of this, SAMMPRIS is evaluating stenting plus intensive medical therapy vs. intensive medical therapy alone. The objective of this proposal is to understand the causes of stroke in those with narrowed brain arteries and stented brain arteries through the use of non-invasive imaging tests such as ultrasound and MRI.

描述(由申请者提供)：颅内狭窄和支架植入的中风机制(MoSISS)这项提案是对SAMMPRIS进行的一项前瞻性的多中心辅助研究，SAMMPRIS是一项正在进行的试验，由美国国立卫生研究院资助，对最近出现症状的高度颅内狭窄进行颅内支架加强化药物治疗与单独强化药物治疗的比较。这项应用的目的是了解支架和非支架患者缺血性中风的潜在机制，因为SAMMPRIS中没有包括机械学方面和相关的影像分析。这一建议的结果将有助于确定预测中风风险的适当参数，并可能导致解决中风特定机制的新疗法。我们的主要假设是，在颅内动脉粥样硬化中，有几种机制是缺血性脑梗塞的基础。这项建议将评估SAMMPRIS队列样本中中风的6种具体机制：前向血流减少、狭窄进展、近端侧支血流减少、远端侧支血流减少、脑血管储备受损和动脉-动脉栓塞。主要结果将是在有症状的动脉区域内发生缺血性中风，这是SAMMPRIS研究的主要终点。SAMMPRIS研究将对100名接受药物治疗和50名植入支架的患者进行研究，采用3种成像方法，包括：a)在SAMMPRIS随机分组之前进行常规血管造影术；b)基线QMRA评估容量血流速度，以此作为顺行血流和近侧支循环血流的标志；c)连续TCD测量基线、4、8、12和24个月以及缺血性中风发生时的血流速度；d)基线TCD检测颅内颈动脉或大脑中动脉狭窄患者的栓子信号；e)屏气基线TCD评估颅内颈动脉或大脑中动脉狭窄患者的血管运动反应性。 公共卫生相关性：LAY综述：脑血管狭窄和支架形成的中风机制(MoSISS)MoSISS是正在进行的预防脑血管狭窄复发的支架和积极医疗管理(SAMMPRIS)研究的辅助研究。由于斑块形成(颅内动脉粥样硬化性疾病)导致的脑动脉狭窄是中风的常见原因。中风复发的风险很大，特别是那些狭窄程度超过70%的人，即使用药物治疗也是如此。正因为如此，SAMMPRIS正在评估支架植入加强化药物治疗与单独使用强化药物治疗的对比。这项建议的目的是通过使用超声波和核磁共振等非侵入性成像测试来了解脑动脉狭窄和支架脑动脉患者中风的原因。