Assessing brain perfusion using IPEN during intra-arterial stroke intervention

项目摘要 在美国，缺血性中风是导致长期残疾的主要原因。幸运的是，这里的风景 近年来，血管内机械血栓切除术(EVT)改变了对中风患者的管理 好几年了。EVT是一种介入性手术，将导致中风的血栓(血块)从大脑动脉移至 诱导再通畅。理所当然，EVT在安全性和有效性方面的进一步改进将继续下去 以改善中风的结果。EVT成功的一个关键是使用灌注成像进行患者选择 评估下游血管床和侧支的生存能力。可回收的组织可能会受益 而血管再通后出血转化(HT)的风险更大 当梗塞(死亡组织)面积较大时(&gt；50-70毫升)。脑侧支循环保留可挽救的组织 存活并减缓梗塞核心的生长；然而，侧支循环的强度变化很大。 患者之间的时间间隔，预计随着时间的推移将变得不足(即使在 提供EVT)。因此，评估每个患者使用EVT的风险-收益比是必要的。 灌注成像；然而，当前护理标准的问题是无法进行实时， 术中脑血流灌注成像。在这个项目中，我们建议开发一种名为IPEN v2的新方法 使用标准x射线血管造影术在介入治疗套间进行定量脑血流灌注成像 图像。IPEN(无支架旋转的介入内灌注)将为介入放射科医生提供 关键的实时信息采取多个步骤，以更安全、更有效地执行EVT。在R21下 项目中，我们开发了IPEN v1，它可以评估多个体积区域的3D组织灌注。 直接从血管造影图像获取感兴趣区域(ROI)。一项针对肝脏肿瘤的模拟研究表明， 即使感兴趣区在血管成像图像上重叠，灌注指数也是准确的。以此为基础 基金会，本项目的具体目标1是开发用于脑血流灌注评估的IPEN v2。具体目标2 是使用患者数据验证IPEN v2。我们将回顾访问300组中风患者的数据 通过标准护理获得，并从多方面验证IPEN。具体目标3是评估IPEN v2 使用计算机模拟数据。到这个项目结束时，我们将完全开发和验证IPEN v2 以实现EVT的必要改进。然后我们将开始与制造商进行对话，以 在他们的血管造影术系统中实施IPEN。

Project Summary Ischemic stroke is the leading cause of long-term disability in the United States. Fortunately, the landscape of stroke patient management has been changing by endovascular mechanical thrombectomy (EVT) in recent years. EVT is an interventional procedure to remove a stroke-causing thrombus (clot) from a cerebral artery to induce recanalization. It stands to reason that further improvements of EVT in safety and efficacy will continue to improve stroke outcomes. One key to the success of EVT is patient selection using perfusion imaging that assesses the viability of the downstream vascular bed and collaterals. Salvageable tissue will likely benefit from reperfusion by EVT, whereas the risk of post-recanalization hemorrhagic transformation (HT) is larger when infarct (dead tissue) size is large (>50–70 ml). Cerebral collateral circulation keeps salvageable tissue viable and slows down the infarct core growth; however, the strength of the collateral circulation varies strongly between patients and it is expected to become insufficient over time (even within the time window in which EVT is offered). Therefore, it is essential to assess the risk–benefit ratio of EVT for each patient using perfusion imaging; however, the problem with the current standard of care is an inability to perform real-time, intra-operative brain perfusion imaging. In this project, we propose to develop a novel method called IPEN v2 to perform quantitative brain perfusion imaging in the interventional suite using standard x-ray angiography images. IPEN (Intra-intervention PErfusion with No gantry rotation) will provide the interventional radiologist critical, real-time, information to take multiple steps to perform EVT safely and more effectively. Under an R21 project, we developed IPEN v1 which can assess the 3D tissue perfusion of multiple volumetric regions-of- interest (ROIs) directly from angiography images. A simulation study for liver tumor oncology showed that the perfusion indices were accurate even though ROIs were overlapped in angiography images. Building upon this foundation, Specific Aim 1 of this project is to develop IPEN v2 for brain perfusion assessment. Specific Aim 2 is to validate IPEN v2 using patient data. We will retrospectively access 300 sets of stroke patient data acquired via standard of care and validate IPEN with multiple aspects. Specific Aim 3 is to assess IPEN v2 using computer simulated data. By the end of this project, we will have IPEN v2 fully developed and validated to enable the necessary improvements of EVT. We will then start the conversation with manufactures for implementing IPEN in their angiography systems.