Automated imaging analysis in acute stroke patients to predict infarct core and growth

Stroke is a devastating disease and a leading cause of mortality and handicap over the world. In patients with ischemic stroke the obstruction of a blood vessel will result in neurological symptoms which can be temporarily if blood flow is restored in time, or persistent if this will not occur in time, resulting in brain ischemia. The development of brain ischemia is time dependent with large individual variation in infarct growth likely resulting in individual based time windows for acute treatment of patients. The size of the baseline infarct and the growth rate are predictors of the final infarct volume and clinical outcomes. Despite the expanded indication for endovascular therapy, many patients remain ineligible because their baseline infarct size is too large. To increase the number of patients eligible for endovascular stroke therapy and to improve the outcomes of patients undergoing endovascular therapy, it is critical to develop treatments that slow infarct growth before blood flow can be restored. Neuroprotective drugs which can prolong the time window in which the brain can withstand the reduced cerebral perfusion can only be effective in patients in whom the infarct is predicted to increase over time before perfusion is restored. Therefore individual prediction of baseline infarct and growth rate as proposed in this project will enable precision based management of stroke patients for both reperfusion therapy and neuroprotective drugs.