CT Perfusion Imaging for Subarachnoid Hemorrhage

(CT-PIPS Trial)

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Nova Scotia Health Authority

Disqualifiers: Age, Non-compliance, Pregnancy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial investigates a special CT scan technique called CT perfusion to determine if it can predict which patients will develop vasospasm (a condition where blood vessels narrow) after a brain bleed from a ruptured aneurysm. Vasospasm can lead to strokes and other severe complications following such brain hemorrhages. The trial aims to use CT perfusion scans at specific times to identify patients at risk for this condition. It may suit patients who have experienced a brain hemorrhage due to an aneurysm and can commit to follow-up visits. As an unphased study, this trial offers patients the chance to contribute to innovative research that could enhance future care for brain hemorrhage patients.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that CT perfusion imaging is safe for patients with subarachnoid hemorrhage?

Research has shown that CT perfusion imaging is generally safe for patients. This type of CT scan helps doctors observe blood flow in the brain. Studies have found it useful for identifying brain areas at risk after a brain bleed.

One concern with CT scans is radiation exposure. However, guidelines exist to minimize this risk and ensure safety. Overall, CT perfusion is well-tolerated and commonly used in hospitals to evaluate brain conditions. No significant problems have been specifically attributed to CT perfusion imaging itself. ^{1 2 3 4 5}

Why are researchers excited about this trial?

CT Perfusion Imaging for subarachnoid hemorrhage is unique because it offers a detailed look at blood flow in the brain, which can help detect complications early. Unlike traditional imaging methods, which might only show the presence of blood, CT Perfusion can provide real-time data on how well oxygen and nutrients are being delivered to brain tissue. Researchers are excited because this technique could lead to quicker, more targeted treatments, potentially improving outcomes for patients by identifying issues before they cause serious damage.

What evidence suggests that CT perfusion is effective for predicting vasospasm in subarachnoid hemorrhage patients?

Research has shown that CT perfusion imaging, which all participants in this trial will undergo, can help predict which patients with subarachnoid hemorrhage (SAH) are at risk of developing vasospasm, a condition that can lead to stroke and death. Studies have found that CT perfusion can detect changes in brain blood flow, helping to identify patients likely to experience delayed cerebral ischemia, a type of stroke. One study showed that CT perfusion could assess patients for possible vasospasm after SAH, aiding in predicting poor outcomes. Another study found that CT perfusion imaging could predict recovery outcomes in SAH patients using machine learning. Overall, CT perfusion appears promising in identifying and managing risks in SAH patients. ^{2 3 6 7 8}

Who Is on the Research Team?

Gwynedd E Pickett, MD

Principal Investigator

Capital District Health Authority, Halifax, Canada

Are You a Good Fit for This Trial?

This trial is for individuals aged 18-75 who have had a brain hemorrhage due to a ruptured aneurysm and can consent to participate. They must be able to attend follow-up visits and not be in another study, pregnant, breastfeeding, or expected to pass away within 24 hours.

Inclusion Criteria

Patient or next of kin or person with appropriate power of attorney has provided written informed consent

Patient is willing and available for study follow-up visits

Patient has not been previously entered into this study

Exclusion Criteria

Inability to obtain informed written consent

Patient history indicates high risk of non-compliance (e.g., substance abuse, psychosocial issues, etc.)

Patient is currently breast feeding, or pregnant

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Baseline Assessment

CT perfusion imaging performed on admission to measure cerebral blood flow and other parameters

Baseline

1 visit (in-person)

Monitoring

CT perfusion imaging on day 6 post-hemorrhage to assess risk of vasospasm and delayed cerebral ischemia

6 days post-SAH

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after initial assessments, including radiation dose and delayed cerebral ischemia

30 days post-SAH

What Are the Treatments Tested in This Trial?

Interventions

• CT Perfusion

Trial Overview The trial tests if CT perfusion scans can predict vasospasm—a dangerous narrowing of blood vessels in the brain after hemorrhage—by performing scans when patients are admitted and again on day six.

How Is the Trial Designed?

Group I: CT Perfusion Experimental Treatment 1 Intervention

All patients enrolled in the study

Who Is Running the Clinical Trial?

Nova Scotia Health Authority

Lead Sponsor

Trials

302

Recruited

95,300+

Gwynedd Pickett

Lead Sponsor

Trials

1

Recruited

40+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4159608/

CT Perfusion for Detection of Delayed Cerebral Ischemia in ... Evaluating CT perfusion using outcome measures of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage. AJNR Am J Neuroradiol 2013;34:292–98 [DOI] ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT03214705

Role of CT Perfusion in Predicting Poor Outcome After ... CT Perfusion can be used in the evaluation of patients with possible vasospasm after subarachnoid hemorrhage (SAH). It can thus be used to assess cerebral ...

3. nature.com nature.com/articles/s41746-025-01953-z

Prediction of functional outcomes in aneurysmal ... Machine learning using presentation CT perfusion imaging for predicting clinical outcomes in patients with aneurysmal subarachnoid hemorrhage.

4. frontiersin.org frontiersin.org/journals/radiology/articles/10.3389/fradi.2024.1445676/full

CT perfusion imaging in aneurysmal subarachnoid ... Cortical blood flow insufficiency scores with computed tomography perfusion can predict outcomes in aneurysmal subarachnoid hemorrhage patients: a cohort study.

5. ahajournals.org ahajournals.org/doi/10.1161/JAHA.121.023828

Diagnostic Performance of Computed Tomography ... Methods and Results. Retrospective analysis of 540 arterial segments from 36 encounters in 31 consecutive patients with aneurysmal subarachnoid ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11491345/

CT perfusion imaging in aneurysmal subarachnoid ... Different studies have investigated the relationship between vasospasm on CT angiography (CTA) and CTP findings and there is some discrepancy in their results.

7. ajronline.org ajronline.org/doi/10.2214/AJR.09.3786

Utilization Guidelines for Reducing Radiation Exposure in the ... OBJECTIVE. The purpose of this study was to reduce the cumulative radiation exposure from CT of patients with aneurysmal subarachnoid ...

8. ajnr.org ajnr.org/content/35/5/866

CT Perfusion for Detection of Delayed Cerebral Ischemia in ... The purpose of this study was to evaluate the usefulness of CTP in determining delayed cerebral ischemia in patients with aneurysmal SAH.