RTPAMON

Diffuse-Optical Monitor of Cerebral Hemodynamics after rtPA Administration in Acute Ischemic Stroke

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 Obiettivo del progetto (Objective)

'Ischemic stroke is the leading cause of morbidity and long term disability in Europe and United States and one of the leading causes of death. The intravenous recombinant tissue-type plasminogen activator (rtPA) is the premier drug indicated for treatment of acute ischemic stroke. Current guidelines call for its administration within the first ~three hours of the stroke onset (now being extended to 4.5 hours due to positive results of ECASS III study). However, despite its success, about 50% of patients treated with rtpa suffer morbidity and even death. It is during this initial emergency treatment phase that a multitude of monitors are deployed in order to monitor the reperfusion (or lack thereof) of the ischemic parenchyma before widespread necrosis takes place. In this multidisciplinary project, I bring together biomedical physicists and clinical neurologists to develop a novel diffuse optical technology to continuously, non-invasively and at the bed-side monitor microvascular, local, cerebral blood oxygenation, cerebral blood volume and cerebral blood flow. Proposed technological developments will enable the use of this technology in a challenging environment such as that of the emergency care of acute ischemic stroke. We will monitor hemodynamics in penumbral regions before, during and after rtPA administration. A particular issue of interest would be the onset of recanalization and its sustainment. This pilot data will be used to assess the value of these monitors to follow the effects of recanalization (or lack thereof) on local microvascular metabolism. If successful, it may provide clinicians with the ability to individualize rtPA treatment and also to develop secondary interventions to improve the treatment outcome. This, in turn, should reduce socio-economic costs of stroke care and improve the overall health of Europeans. I believe that this project would be a key development to translate these promising technologies for clinical use.'

Introduzione (Teaser)

Ischaemic stroke, a blockage in an artery in the brain, requires immediate medical treatment. An EU project has developed instruments to monitor the crucial development of the stroke effects in the emergency room.

Descrizione progetto (Article)

The leading cause of long-term disability in Europe and the United States is ischaemic stroke. Despite the success of the currently used treatment, recombinant tissue-type plasminogen activator (rtPA), about half of all patients suffer morbidity. Surgeons need immediate information on whether new paths have been created at the site of the clot, a process called recanalisation.

The 'Diffuse-optical monitor of cerebral hemodynamics after rtPA administration in acute ischemic stroke' (RTPAMON) project brought together biomedical physicists and clinical neurologists to develop appropriate equipment.

The researchers developed three generations of monitoring equipment. Positive results from the first established the range of healthy cerebro-vascular reactivity (CVR) index in healthy volunteers. RTPAMON compared diffuse optical measurements with those of the transcranial Doppler ultrasound instrumentation.

The second phase corrected the problems apparent in the first phase from feedback. Studies using the second generation have compiled data on changes in the CVR due to lesions in carotid arteries and again compared them with healthy individuals. There were significant differences in micro- and macro-vascular response.

As the second generation device is available for use in hospitals, RTPAMON have trained the collaborating neurologists in its use. The doctors collected data from a group of patients during the initial emergency room management that included administration of rtPA.

Development of the third generation machine led to the formation of a spin-off company, HemoPhotonics. The new set-up will commercialise the technology for a variety of applications.