Quantifying Collateral Perfusion in Cerebrovascular Disease-Moyamoya Disease and Stroke Patients

Quantifying Collateral Perfusion in Cerebrovascular Disease-Moyamoya disease and stroke patients

In the early hours following large vessel occlusion, the ultimate severity of the stroke is largely determined by the ability of collateral flow networks to supply blood to ischemic tissue via circuitous routes that bypass the proximal clot. Robust collateral flow can improve response to thrombolytic therapy and decrease the risk of intracranial hemorrhage. Despite their central importance, collaterals during acute stroke are poorly understood, largely because assessment has required an invasive imaging test, cerebral angiography. This proposal assesses whether a noncontrast MRI perfusion technique, called arterial spin labeling (ASL), can yield important information about collateral flow.

A total of 120 patients will be recruited (60 Moyamoya and 60 acute stroke). All Moyamoya patients will receive XeCT and MRI scans with ASL sequencing in addition to their standard clinical procedures. Acute stroke patients will receive 2 MRI studies each (one <24 hours from symptom onset, the other in the 3-5 day period for determination of final infarct size) and an acute xeCT study (totaling 120 MRI and 60 xeCT studies).

A subarm of the study will include an additional 60 patients and 30 normal subjects who will not receive xeCT or conventional angiography, but who will undergo a single 60 min MRI study with images acquired before and after 1 g of intravenous acetazolamide for the purposes of determining the feasibility of replacing xeCT-based methods.

• Cerebrovascular Accident
• Moyamoya Disease

• Moyamoya patients
  60 MOyamoya patients will be enrolled.
• Acute Stroke
  60 acute stroke patients will be enrolled
• normal and diagnosis unspecified
  A sub-group of 60 patient without specified diagnoses and 30 normals will be enrolled.

Inclusion Criteria:

Moyamoya Patient Inclusion Criteria:

• Men and non-pregnant women, at least 21 years of age.
• Outpatients seen at the Stanford Neurosurgery and Neurology Departments.
• Ability to comply with all studies.
• Inclusion of Moyamoya patients with Sulfa allergies.
• Patients diagnosed with or suspected to have Moyamoya disease.

Stroke Patient Inclusion Criteria:

• Men and non-pregnant women, at least 21 years of age.
• Patients admitted to the inpatient Stanford Stroke Service for stroke-like symptoms, less than 24 hours from last time seen normal.
• Ability to comply with all studies.

Clinical Patient Acetazolamide MRI Inclusion Criteria:

• Men and non-pregnant women, at least 21 years of age.
• Patients admitted to the inpatient Stanford Stroke Service or Neurosurgical -Service for symptoms compatible with cerebrovascular disease.
• Ability to comply with all studies.

Normal Subject Inclusion Criteria:

• Ability to comply with the MRI study.

Exclusion Criteria:

• Level of consciousness score of 2 or greater as defined by the NIH stroke scale.
• Symptoms likely related to psychoactive drugs or patients with symptoms related to an active inflammatory disease such as AIDS, meningitis, or cerebritis.
• Psychiatric or substance abuse disorder or dementia that interferes with evaluation or interpretation of the neurologic and mental assessment of these patients.
• Informed consent cannot be obtained either from the patient or legal representative.
• Severe coexisting or terminal systemic disease that limits life expectancy or that may interfere with the conduct of the study.
• Symptoms related to an alternative diagnosis such as seizures or migraine.
• Patients receiving any thrombolytic agent or receiving acute stroke investigational drug therapies during the 30-day study.