CTP to predict Response to recanalization in Ischemic Stroke Project (CRISP)

CTP 预测缺血性中风再通反应项目 (CRISP)

基本信息

批准号：
8431810
负责人：
MAARTEN G LANSBERG
金额：
$ 56.13万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-01 至 2016-02-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8431810
关键词：
Accident and Emergency department Algorithms Benefits and Risks Blood flow Brain Brain Mapping Cerebral hemisphere hemorrhage Cessation of life Clinical Clinical Data Clinical Trials Cohort Studies Computer Retrieval of Information on Scientific Projects Database Computer software Data Dependence Emergency Situation Goals Head Hospitals Hour Housing Image Infarction Injury Intervention Ischemic Stroke Lead MRI Scans Magnetic Resonance Imaging Malignant - descriptor Maps Methods Odds Ratio Outcome Patient Schedules Patient Selection Patients Perfusion Physicians Population Procedures Process Randomized Controlled Trials Recruitment Activity Reperfusion Therapy Research Scanning Site Solutions Stroke System Technology Testing Tissues United States Universities X-Ray Computed Tomography acute stroke base clinical practice cohort design disability disability burden effective therapy experience follow-up inclusion criteria programs prospective randomized placebo controlled trial randomized trial response restoration standard of care tool

项目摘要

Project Summary Stroke is the number one cause of disability in the United States. In order to reduce the burden of disability caused by stroke there is a need for better stroke treatments that are available to more stroke victims. Endovascular therapies are increasingly being used and may fill this need as they have high rates of recanalization. It is, however, not known which patients benefit clinically. Previous studies suggest that stroke patients with a small volume of irreversible ischemic injury (infarct core) and a large volume of reversible ischemic injury (penumbra) are most likely to benefit from restoration of blood flow. MRI shows promise for identification of the ischemic core and penumbra but it has very limited availability in US emergency rooms. Computed Tomography Perfusion (CTP) imaging is a potential solution as it is widely available and can easily be added to a non-contrast head CT, already routinely obtained to evaluate stroke patients in the emergency room. However, methods for processing of CTP images and criteria for interpretation of the images are still immature. Therefore, patient selection based on CTP images is not ready for implementation in clinical trials or clinical practice. The overall goal of the CTP to predict Response to recanalization in Ischemic Stroke Project (CRISP) is to develop a practical tool to identify acute stroke patients who are likely to benefit from endovascular therapy. The project has two main parts. During the first part (year 1), we propose to develop a fully automated system (RAPID) for processing of CT Perfusion (CTP) images that will generate brain maps of the ischemic core and penumbra. We will also define criteria, based on these CTP maps, which predict if a patient is likely to benefit from restoration of blood flow. These criteria will be based on data from a retrospective cohort of 95 patients treated at St Luke's hospital. During the second part (years 2-5), we aim to demonstrate that physicians in the emergency setting, with the aid of a fully automated CTP analysis program (RAPID), can accurately predict response to recanalization in stroke patients undergoing revascularization. To achieve this aim we will conduct a prospective cohort study of 100 consecutive stroke patients who will undergo a CTP scan prior to endovascular therapy. The study will be conducted at two sites (Stanford University and St Luke's Hospital). Patients will have an early follow-up scan within 6 hours to assess reperfusion and a late follow-up scan at day 5 to determine the final infarct. The successful execution of this research will provide physicians with an easy, automated method to select patients who are likely to benefit from restoration of blood flow. Such a method, thanks to easy accessibility to CT technology, would be of great value for patient selection in multi-center clinical acute stroke trials and, eventually, in routine clinical practice.

项目概要中风是美国第一大致残原因。为了减轻残疾负担中风引起的中风需要更好的中风治疗方法，以供更多的中风患者使用。血管内治疗的使用越来越多，并且可能满足这一需求，因为它们的发生率很高。再通。然而，尚不清楚哪些患者在临床上受益。既往研究表明，中风患者存在小体积不可逆的缺血性损伤（梗死）核心）和大量可逆性缺血性损伤（半影）最有可能受益于恢复血流（量。 MRI 显示了识别缺血核心和半暗带的希望，但其局限性非常有限美国急诊室的可用性。计算机断层扫描灌注 (CTP) 成像是一种潜在的解决方案它应用广泛，可以轻松添加到非对比头部 CT 中，已常规获取用于评估急诊室里的中风患者。然而，CTP图像的处理方法和标准对图像的解释仍然不成熟。因此，基于CTP图像的患者选择还没有准备好用于临床试验或临床实践中的实施。 CTP 预测缺血性中风项目 (CRISP) 中再通反应的总体目标是开发一种实用工具来识别可能受益于血管内治疗的急性中风患者。该项目有两个主要部分。在第一部分（第一年），我们建议开发一个完全自动化的系统 (RAPID)，用于处理 CT 灌注 (CTP) 图像，生成缺血性脑图核心和半影。我们还将根据这些 CTP 图定义标准，预测患者是否可能受益于血流的恢复。这些标准将基于 95 名患者的回顾性队列数据在圣卢克医院接受治疗的病人。在第二部分（2-5 年），我们的目标是证明医生在紧急情况下，借助全自动 CTP 分析程序 (RAPID)，可以准确预测再通反应接受血运重建的中风患者。为了实现这一目标，我们将进行一项前瞻性队列研究 100 名连续中风患者在血管内治疗前接受 CTP 扫描。该研究将在两个地点（斯坦福大学和圣卢克医院）进行。患者将得到早期随访 6 小时内扫描以评估再灌注，并在第 5 天进行后期随访扫描以确定最终梗塞情况。这项研究的成功执行将为医生提供一种简单、自动化的方法来选择可能受益于血流恢复的患者。这种方法，由于易于访问 CT技术对于多中心临床急性卒中试验的患者选择具有重要价值，最终，在常规临床实践中。