# Assessing brain perfusion using IPEN during intra-arterial stroke intervention

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2024 · $623,553

## Abstract

Project Summary
Ischemic stroke is the leading cause of long-term disability in the United States. Fortunately, the landscape of
stroke patient management has been changing by endovascular mechanical thrombectomy (EVT) in recent
years. EVT is an interventional procedure to remove a stroke-causing thrombus (clot) from a cerebral artery to
induce recanalization. It stands to reason that further improvements of EVT in safety and efficacy will continue
to improve stroke outcomes. One key to the success of EVT is patient selection using perfusion imaging that
assesses the viability of the downstream vascular bed and collaterals. Salvageable tissue will likely benefit
from reperfusion by EVT, whereas the risk of post-recanalization hemorrhagic transformation (HT) is larger
when infarct (dead tissue) size is large (>50–70 ml). Cerebral collateral circulation keeps salvageable tissue
viable and slows down the infarct core growth; however, the strength of the collateral circulation varies strongly
between patients and it is expected to become insufficient over time (even within the time window in which
EVT is offered). Therefore, it is essential to assess the risk–benefit ratio of EVT for each patient using
perfusion imaging; however, the problem with the current standard of care is an inability to perform real-time,
intra-operative brain perfusion imaging. In this project, we propose to develop a novel method called IPEN v2
to perform quantitative brain perfusion imaging in the interventional suite using standard x-ray angiography
images. IPEN (Intra-intervention PErfusion with No gantry rotation) will provide the interventional radiologist
critical, real-time, information to take multiple steps to perform EVT safely and more effectively. Under an R21
project, we developed IPEN v1 which can assess the 3D tissue perfusion of multiple volumetric regions-of-
interest (ROIs) directly from angiography images. A simulation study for liver tumor oncology showed that the
perfusion indices were accurate even though ROIs were overlapped in angiography images. Building upon this
foundation, Specific Aim 1 of this project is to develop IPEN v2 for brain perfusion assessment. Specific Aim 2
is to validate IPEN v2 using patient data. We will retrospectively access 300 sets of stroke patient data
acquired via standard of care and validate IPEN with multiple aspects. Specific Aim 3 is to assess IPEN v2
using computer simulated data. By the end of this project, we will have IPEN v2 fully developed and validated
to enable the necessary improvements of EVT. We will then start the conversation with manufactures for
implementing IPEN in their angiography systems.

## Key facts

- **NIH application ID:** 10835898
- **Project number:** 5R01NS126256-03
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Katsuyuki Taguchi
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $623,553
- **Award type:** 5
- **Project period:** 2022-03-01 → 2026-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10835898

## Citation

> US National Institutes of Health, RePORTER application 10835898, Assessing brain perfusion using IPEN during intra-arterial stroke intervention (5R01NS126256-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10835898. Licensed CC0.

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