Acute Stroke: Imaging The Ischaemic Penumbra With Perfusion CT
Funder
National Health and Medical Research Council
Funding Amount
$243,000.00
Summary
The burden of stroke is large. Clot-dissolving medication (thrombolysis) may dramatically improve the outcome of many patients with severe stroke by unblocking the affected brain artery. However, very few patients receive this medication, as the current approval is restricted to treatment within 3 hours of stroke onset. The major aim of thrombolysis is to rescue brain tissue with reduced blood flow (the ischaemic penumbra) from becoming irreversibly damaged (infarcted). The penumbra progressivel ....The burden of stroke is large. Clot-dissolving medication (thrombolysis) may dramatically improve the outcome of many patients with severe stroke by unblocking the affected brain artery. However, very few patients receive this medication, as the current approval is restricted to treatment within 3 hours of stroke onset. The major aim of thrombolysis is to rescue brain tissue with reduced blood flow (the ischaemic penumbra) from becoming irreversibly damaged (infarcted). The penumbra progressively becomes infarcted over the next 48 hours if blood flow is not restored by the blood clot in the brain artery being dissolved. Penumbral brain tissue cannot be identified with clinical assessment or standard CT scanning. New generation CT scanners are capable of assessing brain blood flow. Perfusion CT imaging (CTP) is well tolerated and time-efficient, and can be integrated into the brain CT scanning process performed on all stroke patients. Preliminary evidence suggests that CTP can distinguish between tissue that represents the ischaemic penumbra, and tissue that is already permanently injured. This project aims to validate the use of CTP in imaging the ischaemic penumbra. This will be based on testing the accuracy of CTP tissue signatures of the penumbra in predicting clinical outcome and final stroke size. This is the only national collaborative study planned worldwide for this relatively new but increasingly accessible imaging technique. The ability to rapidly identify under-perfused but still viable brain with CTP would add new and exciting management options to the routine emergency assessment of stroke patients. The results of this unique study could have a significant impact on the management of acute stroke worldwide. If validated, it is anticipated that CTP would be widely used to improve patient selection for stroke thrombolysis, especially in safely extending the time window so that a greater number of patients can be treated with better outcomes.Read moreRead less
Improved Identification Of At-risk Brain Tissue In Patients With Stroke
Funder
National Health and Medical Research Council
Funding Amount
$279,044.00
Summary
Stroke is one of the most frequent causes of death and the major cause of adult neurological disability. Diagnostic tools to improve its management are therefore crucial. This project is dedicated to improving the magnetic resonance imaging techniques for measuring blood flow to the brain, and to applying these to patients who have had a stroke. Improved methods will enable better prediction of tissue outcome following stroke, thus enabling optimal early management decisions to be taken.
Low-Dose Tenecteplase Vs Standard-Dose Alteplase For Acute Ischaemic Stroke: An Imaging Based Safety And Efficacy Study
Funder
National Health and Medical Research Council
Funding Amount
$349,281.00
Summary
This study compares standard dose alteplase (a proven stroke thrombolytic) with a low dose of the new medication tenecteplase for stroke treatment. We propose that the clot-dissolving activity of low-dose tenecteplase will be superior to alteplase, with a lower risk of brain bleeding. MRI scanning is the most effective way of assessing outcomes and will be used to measure how well the medication restores blood flow, the amount of permanent brain damage, and whether any brain bleeding occurs.