Advanced Imaging in Neuro-Interventional Surgery

King, Robert M.

Etd

Advanced Imaging in Neuro-Interventional Surgery

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There are over 15 million cases of stroke each year worldwide, with approximately 1/3 of these resulting in death, and another 1/3 in serious disability. Within the United States, stroke has become a leading cause of permanent disability. The two major subtypes of stroke are hemorrhagic, a bleed often from a ruptured aneurysm, and ischemic, a blockage of flow. Endovascular treatment for both causes of stroke has become standard of care for selected patients. Two main imaging modalities will be explored within this body of work, intravascular optical coherence tomography (OCT) and magnetic resonance imaging (MRI), looking at each stroke subtype for its unique contribution to improve patient outcome. The ability of OCT to image intravascular spaces, at near-histology resolution, will allow us to develop analysis and segmentation tools that look to prognosticate on the rate and overall success of an endovascular treatment. Furthermore, we can look at endovascular implants in the acute phase, detecting any immediate thrombus or malapposition that may cause delayed ischemic injury. With all the advances in endovascular treatment of ischemic stroke, rates of successful embolus removal have reached over 85%; however, the number of patients who have a good clinical outcome remains at under 50%. In order to develop new therapeutics animal models that closely mimic the natural progression within the human populations must be developed. Here we have designed a method for analyzing MR imaging data to identify both the final volume and rate of ischemic stroke progression within a canine model of large vessel occlusion. From here, we have successfully applied this new model and analysis technique to test a novel oxygen carrier therapy that can reduce the rate of infarct progression, allowing for more time for intervention.

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