CT Perfusion to Predict Response to Recanalization in Ischemic Stroke Project 2 (CRISP 2)

CT 灌注预测缺血性中风再通反应项目 2 (CRISP 2)

• 批准号: 9923737
• 负责人: MAARTEN G LANSBERG
• 金额: $ 63.26万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9923737
• 关键词: Acute; Address; Animals; Blood Vessels; Blood flow; Brain; Brain Injuries; Cerebrovascular Circulation; Cessation of life; Clinical; Clinical Data; Clinical Research; Clinical Trials; Community Hospitals; Conduct Clinical Trials; Country; Data; Data Set; Evolution; Failure; Future; Gold; Growth; Guidelines; Hospitals; Hour; Human; Image; Imaging Device; Individual; Infarction; Injury; Ischemic Stroke; Knowledge; Lesion; Magnetic Resonance Imaging; Maps; Measurement; Measures; Mediating; Medical; Methodology; Methods; Modeling; Neuroprotective Agents; Outcome; Patient Selection; Patient Transfer; Patient-Focused Outcomes; Patients; Perfusion; Population; Prospective cohort study; Public Health; Randomized Controlled Trials; Research; Sampling; Specificity; Stroke; Symptoms; Testing; Therapy Clinical Trials; Time; United States; Vascular blood supply; X-Ray Computed Tomography; acute stroke; base; clinical practice; design; disability; effective therapy; experience; functional independence; functional outcomes; improved; improved outcome; individual patient; insight; medical specialties; multimodality; neural network; novel; patient stratification; perfusion imaging; predicting response; predictive modeling; standard of care; stroke patient; stroke therapy; success; tool

Project Summary Stroke is the number 1 cause of disability in the United States and a global public health problem. Globally, approximately 15 million people suffer a stroke each year, leading to 5 million deaths and another 5 million patients who suffer permanent disability from their stroke. Strokes that are caused by blockage of large blood vessels supplying blood to the brain are typically the most disabling. Over the last 5 years, there have been major breakthroughs in acute stroke therapy for this type of stroke. In 2015, multiple trials demonstrated a profound benefit from endovascular stroke therapy for patients with a large vessel ischemic stroke who present in the early time-window (within 6 hours after symptom onset). This success was followed by the DEFUSE 3 and DAWN trials showing a very strong benefit from endovascular therapy in the delayed time-window (6-24 hours after symptom onset). These therapies have now become standard of care at specialty hospitals (comprehensive stroke centers) across the country. Despite this new highly effective therapy, stroke-related disability continues to be substantial for patients with large-vessel occlusions, because of brain damage that occurs in the time-period before patients receive endovascular therapy that restores blood flow to the brain. The time period before blood flow is restored can be long (several hours) especially if patients need to be transferred from a community hospital that does not have the capability to provide endovascular therapy to a comprehensive stroke center that does. Because of this delay, significant brain damage can occur between the time that a patient initially presents to a hospital and the time that blood flow is restored. To address this problem, we need to conduct clinical trials of therapies that protect the brain in the crucial time-period before blood flow is restored. In order to conduct such trials, we first need tools to identify patients who are most likely to benefit from treatments that protect the brain and tools that can be used to determine if the treatments are effective. The overall aim of this project is to develop these tools. We will achieve this aim using both an existing imaging dataset and using new data that we will obtain from patients who are being transferred from a community hospital to a comprehensive stroke center for endovascular therapy. To identify patients who will likely benefit from treatments that protect the brain, we will develop a CT-based tool that visualizes how much brain damage a patient is likely to sustain during transport. To be able to determine if a treatment is effective at protecting the brain, we will develop a CT-based tool that can accurately measure the amount of brain damage (infarct volume) that is already present prior to transport.

项目摘要 中风是美国残疾的第一名，也是全球公共卫生问题。在全球 每年大约有1500万人遭受中风，导致500万人死亡，另有500万人 遭受中风永久残疾的患者。由大血管阻塞引起的中风 向大脑供血的血管通常是最残疾。在过去的5年中， 这种类型的中风的急性中风疗法的主要突破。 2015年，多次试验证明了 内血管中风疗法的深厚益处，可用于大血管缺血性中风的患者 在早期窗口（症状发作后6小时内）。成功之后是Dunduse 3 和黎明试验显示在延迟的时间窗口中血管内疗法受益匪浅（6-24 症状发作后数小时）。这些疗法现在已成为专科医院的护理标准 （全面的中风中心）在全国范围内。尽管采用了这种新的高效疗法，但与中风有关 由于脑部损伤，残疾仍然是大周围闭塞患者的重要性 发生在患者接受血管内疗法之前的时间周期内发生，以恢复流向大脑的血液。这 恢复血液之前的时间段可能很长（几个小时），尤其是在需要转移患者的情况下 从没有能力提供血管内治疗的社区医院到全面 中风中心。由于这种延迟，患者之间可能会发生重大脑部损伤 最初出现到医院以及恢复血液流动的时间。要解决这个问题，我们需要 在恢复血流之前，对保护大脑的疗法进行临床试验。 为了进行此类试验，我们首先需要工具来识别最有可能受益的患者 保护大脑和工具的治疗方法，可用于确定治疗是否有效。这 该项目的总体目的是开发这些工具。我们将使用现有的成像实现这一目标 数据集并使用我们将从从社区医院转移的患者那里获得的新数据 到一个全面的中风中心进行血管内治疗。确定可能从中受益的患者 保护大脑的治疗方法，我们将开发一种基于CT的工具，可视化大脑损伤的程度 患者在运输过程中可能会维持。能够确定治疗是否有效保护 大脑，我们将开发一种基于CT的工具，该工具可以准确测量脑损伤的量（梗塞体积） 在运输之前已经存在。