Collateral circulation is a fundamental component of stroke pathophysiology that has been relatively unexplored. The principal objective of this study is to characterize the nature of collateral circulation in acute ischemic stroke and to evaluate augmentation of oxygen status via collaterals as a therapeutic strategy for acute cerebral ischemia.
The Specific Aims are 1) to establish a standard angiographic rating scale of leptomeningeal collaterals in acute middle cerebral artery (MCA) stroke, 2) to determine accurate MRI correlates of leptomeningeal collateral circulation, 3) to develop a novel physiologic measure for the adequacy of retrograde leptomeningeal collateral blood flow - oxygen sampling of arterial blood distal to MCA occlusion - and employ this measure to investigate the presence and reversibility of deoxygenation in collateral-derived arterial blood, and 4) to demonstrate that endovascular, intracarotid administration of aqueous oxygen to enhance oxygen delivery via leptomeningeal collaterals in patients with acute MCA ischemia is feasible, safe, and potentially efficacious.
These Aims will be addressed in a prospective, nonrandomized, single-center, feasibility, safety, and exploratory efficacy study of endovascular aqueous oxygen delivery in 44 patients within 8 hours of onset of acute ischemic stroke due to MCA occlusion. The rationale for this study is that therapeutic augmentation of oxygen content in leptomeningeal collaterals may diminish ischemia and improve microcirculatory perfusion. Comprehensive angiographic evaluation of collaterals combined with multimodal MRI and oxygen sampling will considerably enhance our current understanding of collateral circulation in acute ischemic stroke. Dynamic aspects of collateral recruitment or collateral failure will be chronicled with serial MRI, including diffusion-perfusion sequences and MRA. As a K23 proposal, this Award will also support a detailed program of didactic coursework and mentored interactive training in clinical research, neuroimaging, and cerebral fluid mechanics, designed to enable the candidate to become a fully independent and productive investigator in patient-oriented cerebrovascular research. The proposed study will lay the foundation for a future era of collateral therapeutics, providing tools and approaches for the evaluation of a wide range of emerging collateral enhancement strategies.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
3K23NS054084-04S1
Application #
7884656
Study Section
NST-2 Subcommittee (NST)
Program Officer
Jacobs, Tom P
Project Start
2006-09-07
Project End
2010-06-30
Budget Start
2009-08-15
Budget End
2010-06-30
Support Year
4
Fiscal Year
2009
Total Cost
$50,000
Indirect Cost
Name
University of California Los Angeles
Department
Neurology
Type
Schools of Medicine
DUNS #
092530369
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Lou, Xin; Yu, Songlin; Scalzo, Fabien et al. (2017) Multi-delay ASL can identify leptomeningeal collateral perfusion in endovascular therapy of ischemic stroke. Oncotarget 8:2437-2443
Yan, Shenqiang; Chen, Qingmeng; Xu, Mengjun et al. (2016) Thrombus Length Estimation on Delayed Gadolinium-Enhanced T1. Stroke 47:756-61
Yu, Songlin; Liebeskind, David S; Dua, Sumit et al. (2015) Postischemic hyperperfusion on arterial spin labeled perfusion MRI is linked to hemorrhagic transformation in stroke. J Cereb Blood Flow Metab 35:630-7
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Froehler, Michael T; Tateshima, Satoshi; Duckwiler, Gary et al. (2013) The hyperdense vessel sign on CT predicts successful recanalization with the Merci device in acute ischemic stroke. J Neurointerv Surg 5:289-93

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