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)

基本信息

批准号：
10397021
负责人：
MAARTEN G LANSBERG
金额：
$ 60.32万
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 2024-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10397021
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 Persons 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

项目摘要

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.

项目概要中风是美国第一大残疾原因，也是全球公共卫生问题。在全球范围内，每年约有 1500 万人遭受中风，导致 500 万人死亡，另有 500 万人死亡因中风而造成永久性残疾的患者。由于大血管阻塞而引起的中风向大脑供血的血管通常是最容易造成功能障碍的。过去 5 年里，已经有此类中风的急性中风治疗取得重大突破。 2015年，多项试验表明对于患有大血管缺血性卒中的患者来说，血管内卒中治疗具有深远的益处在早期时间窗口（症状出现后 6 小时内）。继这一成功之后，DEFUSE 3 和 DAWN 试验显示，延迟时间窗（6-24 症状出现后数小时）。这些疗法现已成为专科医院的标准护理（综合卒中中心）遍布全国。尽管有这种新的高效疗法，但与中风相关的对于大血管闭塞的患者来说，残疾仍然很严重，因为脑损伤发生在患者接受恢复大脑血流的血管内治疗之前的时间段。这血流恢复之前的时间可能很长（几个小时），特别是如果患者需要转移从不具备血管内治疗能力的社区医院到综合性医院中风中心确实如此。由于这种延迟，在患者接受治疗之前可能会发生严重的脑损伤。首先到医院就诊，血流恢复的时间。为了解决这个问题，我们需要对在血流恢复之前的关键时期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的治疗方法以及可用于确定治疗方法是否有效的工具。这该项目的总体目标是开发这些工具。我们将利用现有的成像技术来实现这一目标数据集并使用我们将从社区医院转院的患者那里获得的新数据到综合性中风中心进行血管内治疗。确定可能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，可以直观地显示大脑损伤的程度患者在转运过程中可能会维持生命。为了能够确定治疗是否能有效保护大脑，我们将开发一种基于CT的工具，可以准确测量脑损伤量（梗塞体积）在运输之前就已经存在。