Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke

项目摘要/摘要 在每年70万中风中，超过三分之一发生在后循环，这是导致中风的主要原因 这是动脉粥样硬化性椎基底动脉闭塞症。有症状的椎基底动脉疾病 年中风风险，平均每年10%-15%。血管内成形术和支架置入术的进展 创造了新的治疗选择，但这些干预措施具有重大风险，选择标准 确定合适的候选人仍不确定。在着手进行昂贵的大规模随机 在干预试验中，有必要确定最有可能受益的适当高危人群 治疗。这项研究的总体目标是确定椎基底动脉疾病患者的群体 中风复发风险最高。这一结果将为未来的临床试验奠定基础。 血管内或外科干预。 初步的回顾数据表明，椎基底动脉疾病的中风风险与 损害的颅内血流，其程度可以用定量的 磁共振血管成像(QMRA)。目的是进行前瞻性的多中心观察。 有症状的血管造影证实的椎基底动脉狭窄(？50%)或闭塞患者的研究 检验这样一种假设，即那些表现出血流障碍的人中风的风险更高。vt.在.的基础上 登记后，受试者将接受QMRA的血流动力学评估，以评估大血管血流，而MR 在椎基底动脉区域，评估组织水平的血流灌注。受试者将被前瞻性地 根据现有的初步数据被指定为显示受损或正常的脑血流； 结果将对医生和患者保密。基准临床、实验室和 将系统地收集流行病学数据。患者将每月接受一次随访，为期一年 卒中的主要终点在椎基底动脉区域至少12个月。项目叙事 通过定义中风复发风险最高的人群，这项研究将显著影响 旨在评估干预措施的未来临床试验的选择标准和成功的可能性 椎基底动脉疾病的治疗。此外，能够定义低风险人群，在这些人群中 昂贵的侵入性干预将是不必要的，将会对公众产生同样重要的影响 健康，医疗保健成本，视角。

Project Summary/Abstract Over one third of the 700,000 strokes suffered annually occur in the posterior circulation, a major cause of which is atherosclerotic vertebrobasilar occlusive disease. Symptomatic vertebrobasilar disease carries a high annual stroke risk, averaging 10-15% per year. Advances in endovascular angioplasty and stenting have created new treatment options, but these interventions carry significant risks, and selection criteria for determining appropriate candidates remain uncertain. Prior to embarking on expensive large-scale randomized trials of intervention, it is necessary to define the appropriate high risk population most likely to benefit from treatment. The overall goal of this study is to define the population of patients with vertebrobasilar disease at highest risk of recurrent stroke. The results will be well poised to form the basis for future clinical trials of endovascular or surgical interventions. Preliminary retrospective data indicates that stroke risk in vertebrobasilar disease is strongly related to compromised intracranial blood flow, the extent of which can be measured noninvasively using quantitative magnetic resonance angiography (QMRA). The objective is to conduct a prospective multi-center observational study of patients with symptomatic angiographically confirmed vertebrobasilar stenosis (? 50%) or occlusion to test the hypothesis that those who demonstrate compromised blood flow are at higher stroke risk. Upon enrollment, subjects will undergo hemodynamic assessment with QMRA to assess large vessel flow, and MR perfusion to assess tissue level perfusion, in the vertebrobasilar territory. Subjects will be prospectively designated as demonstrating compromised or normal cerebral flow, based upon existing preliminary data; the results will be kept blinded from treating physicians and patients. Baseline clinical, laboratory, and epidemiological data will be systematically collected. Patients will be followed at monthly intervals for a minimum of 12 months for the primary endpoint of stroke in the vertebrobasilar territory. Project Narrative By defining the population of patients at highest risk of recurrent stroke, this study will significantly impact the selection criteria and likelihood for success of future clinical trials aimed at assessing interventions for the treatment of vertebrobasilar disease. Additionally, the ability to define a low risk population in whom the risks of expensive invasive interventions would be unnecessary will have an equally important impact from a public health, and health care cost, perspective.