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.
Discovery To Therapy Implementation In Acute Stroke
Funder
National Health and Medical Research Council
Funding Amount
$585,269.00
Summary
Advances in acute stroke therapies are occurring rapidly but challenges remain in their safe and effective delivery to stroke sufferers. This research focuses on testing a potentially superior ‘clot busting’ drug therapy for acute stroke and on identifying reasons why one of the most widely used current therapies carries a risk of significant harm due to bleeding into the brain. The work also investigates how to better implement the newest form of acute therapy, mechanical blood clot extraction.
The Influence Of Transcatheter Aortic Valve Implantation On Myocardial Structure And Function
Funder
National Health and Medical Research Council
Funding Amount
$110,218.00
Summary
Transcatheter aortic valve implantation has given options to elderly patients who were previously faced with an open-heart operation. Our research utilises CT scans to determine the anatomical and physiological effects this new technology has on the heart. This research will help to guide the ongoing development and refinement of this technology. The research has the potential to revolutionise how aortic stenosis is assessed and timing of intervention is determined.
Tenecteplase Versus Alteplase For Stroke Thrombolysis Evaluation (TASTE) Trial
Funder
National Health and Medical Research Council
Funding Amount
$4,180,030.00
Summary
Tenecteplase versus Alteplase for Stroke Thrombolysis Evaluation (TASTE) is an Australian-led international randomised trial designed to generate practice-changing evidence by translating the advanced imaging treatment selection approach used in our previous pilot studies. TASTE aims to confirm the superiority of the new-generation clot-dissolving agent, tenecteplase, over the standard agent, alteplase, in the broad group of stroke patients eligible for acute clot-dissolving treatment.
Advanced Imaging For Patient Profiling In Patients With Stroke
Funder
National Health and Medical Research Council
Funding Amount
$319,831.00
Summary
Stroke is the leading cause of adult disability in the developed world. Many patients are require rehabilitation which can vary in terms of its success, and in many cases patients can be left with permanent and significant disability. Approaches to understand the neuroplastic changes associated with poststroke motor impairment are limited. This study aims to further our understanding of stroke recovery by undertaking a longitudinal MRI assessment of patients recovering from stroke.
EXTEND-IA Randomized Trial Of Intra-arterial Clot Retrieval In Ischemic Stroke
Funder
National Health and Medical Research Council
Funding Amount
$764,534.00
Summary
Most strokes are caused by a blocked blood vessel in the brain. Current treatments to dissolve the blockage improve recovery for many patients but often fail to unblock larger brain arteries. The EXTEND-IA trial will use advanced brain imaging to identify patients who have the most to gain if the blocked artery can be re-opened. The trial will test whether a new minimally invasive clot removal procedure performed after standard clot-dissolving treatment improves recovery after stroke.
Implementation Of Quality Use Of Advanced CT Imaging In Acute Stroke
Funder
National Health and Medical Research Council
Funding Amount
$1,128,594.00
Summary
Many centres now use advanced CT scanning techniques to assess stroke patient suitability for clot-dissolving treatment. However, there is major variation across Australia in the clinical application of advanced CT scanning techniques, which is a barrier to the delivery of this treatment. This project addresses the variation in CT imaging techniques by developing, piloting and evaluating the implementation of a standardised advanced CT scanning strategy for acute stroke patients.
Validation Of Point Of CarE CT DeRived FracTionAl Flow Reserve In Stable Coronary Artery Disease (VERITAS)
Funder
National Health and Medical Research Council
Funding Amount
$78,554.00
Summary
In stable coronary artery disease outcomes are dependent on the presence and burden of ischaemia. Current methods of assessing ischaemia are either invasive with associated risks or non-invasive but limited in their diagnostic accuracy. Our research plans to assess the real world feasibility of a novel, non-invasive, point of care CT-Derived Fractional Flow Reserve technique and its potential for guiding clinical decision making and influencing downstream testing.
Short Duration Hypothermia To Prevent Subsequent Intracranial Pressure Rise.
Funder
National Health and Medical Research Council
Funding Amount
$436,453.00
Summary
Elevated brain pressure after stroke or other forms of brain injury can cause further injury and death. Body cooling to 32-33 C (hypothermia) for 12-24 hours saves lives after some forms of brain injury, but may have major side effects. We found that 2 hours hypothermia has a long-lasting effect preventing pressure elevation. We will determine the best temperature and duration of hypothermia in a stroke model and use imaging to confirm findings in patients, with a view to later human trials.