Assessing brain perfusion using IPEN during intra-arterial stroke intervention

动脉内卒中干预期间使用 IPEN 评估脑灌注

基本信息

批准号：
10580843
负责人：
Katsuyuki Taguchi
金额：
$ 64.28万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-03-01 至 2026-02-28
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10580843
关键词：
3-Dimensional Agreement Angiography Arteries Blood flow Brain Brain region Cerebral Angiography Cerebral Infarction Cerebrum Coagulation Process Collateral Circulation Compensation Computers Data Death Rate Distal Foundations Growth Head Hemorrhage Hour Infarction Intervention Ischemia Ischemic Stroke Lesion Letters Liver neoplasms Magnetic Resonance Measures Mechanics Medical Methods Motion Oncology Outcome Patient Admission Patient Selection Patients Perfusion Perfusion Weighted MRI Procedures Reperfusion Therapy Retrieval Risk Risk-Benefit Assessment Roentgen Rays Rotation Safety Scheme Stroke System Techniques Testing Thrombectomy Thrombus Time Tissue Viability Tissues United States Veins Work X-Ray Computed Tomography acute stroke arm blood-brain barrier permeabilization cerebral artery digital disability functional outcomes improved indexing interest manufacture novel perfusion imaging radiologist risk/benefit ratio simulation standard of care stroke intervention stroke outcome stroke patient success thrombolysis vascular bed

项目摘要

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.

项目概要幸运的是，缺血性中风是美国长期残疾的主要原因。近年来，血管内机械血栓切除术（EVT）改变了中风患者的治疗方式 EVT 是一种介入手术，用于清除脑动脉中引起中风的血栓（凝块）。按理说，EVT 的安全性和有效性将继续进一步提高。 EVT 成功的关键之一是使用灌注成像来选择患者。评估下游血管床和侧支循环的活力可能会受益。 EVT 导致再灌注，而再通后出血性转化 (HT) 的风险更大当梗塞（死亡组织）尺寸较大（> 50–70 ml）时，脑侧支循环保留可挽救的组织。可行并减缓梗塞核心的生长；然而，侧支循环的强度差异很大；患者之间的数据预计会随着时间的推移而变得不足（即使在时间窗口内）提供 EVT）因此，有必要评估每位使用 EVT 的患者的风险效益比。灌注成像；然而，当前护理标准的问题是无法进行实时、在这个项目中，我们建议开发一种称为 IPEN v2 的新方法。使用标准 X 射线血管造影在介入套件中进行定量脑灌注成像 IPEN（无机架旋转的介入灌注灌注）将为介入放射科医生提供图像。关键的实时信息，以便在 R21 下采取多个步骤安全、更有效地执行 EVT。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中获得兴趣（ROI）肝脏肿瘤肿瘤学的模拟研究表明，即使 ROI 在血管造影图像中重叠，灌注指数也是准确的。基金会，该项目的具体目标 1 是开发用于脑灌注评估的 IPEN v2。我们将回顾性地访问 300 组中风患者数据来验证 IPEN v2。通过护理标准获得并从多个方面验证 IPEN 具体目标 3 是评估 IPEN v2。到本项目结束时，我们将充分开发和验证 IPEN v2。以便对 EVT 进行必要的改进，然后我们将开始与制造商进行对话。在他们的血管造影系统中实施 IPEN。