Severity assessment of intracranial large artery stenosis by pressure gradient measurements: A feasibility study
Yun-Fei Han1, Wen-Hua Liu2, Xiang-Liang Chen2
1Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China.
Insights
Measuring trans-stenotic pressure gradients using a fluid-filled guidewire is safe and feasible in intracranial large arteries. This technique can help assess stenosis severity and guide revascularization decisions.
Area of Science:
- Neurology
- Interventional Cardiology
- Vascular Medicine
Background:
- Fractional flow reserve (FFR) guides coronary revascularization.
- Feasibility of intracranial pressure gradient measurement for stenosis severity is unclear.
Purpose of the Study:
- To assess the feasibility and safety of measuring trans-stenotic pressure gradients in intracranial large arteries.
- To evaluate the utility of pressure gradients in guiding percutaneous transluminal angioplasty and stenting (PTAS).
Main Methods:
- 12 patients with intracranial stenosis underwent pressure gradient measurements using a 0.014-inch fluid-filled guidewire.
- Measurements were taken before and after PTAS and compared with diameter stenosis.
- A Pd/Pa ratio ≤0.70 guided stenting decisions.
Main Results:
- Successful pressure measurements were obtained in all patients.
- Mean pressure gradient significantly decreased post-PTAS (59.0 to 13.3 mm Hg, P<0.01).
- One transient ischemic attack (TIA) occurred in a patient refusing stenting.
Conclusions:
- Trans-stenotic pressure gradients can be safely and easily measured in intracranial large arteries.
- This method provides valuable hemodynamic information for managing intracranial stenosis.
Background:
Fractional flow reserve (FFR)-guided revascularization strategy is popular in coronary intervention. However, the feasibility of assessing stenotic severity in intracranial large arteries using pressure gradient measurements still remains unclear.
Methods:
Between March 2013 and May 2014, 12 consecutive patients with intracranial large artery stenosis (including intracranial internal carotid artery, middle cerebral M1 segment, intracranial vertebral artery, and basilar artery) were enrolled in this study. The trans-stenotic pressure gradient was measured before and/or after percutaneous transluminal angioplasty and stenting (PTAS), and was then compared with percent diameter stenosis. A Pd /Pa cut-off of ≤0.70 was used to guide stenting of hemodynamically significant stenoses. The device-related and procedure-related serious adverse events and recurrent cerebral ischemic events were recorded.
Results:
The target vessel could be reached in all cases. No technical complications occurred due to the specific study protocol. Excellent pressure signals were obtained in all patients. For seven patients who performed PTAS, the mean pre-procedural pressure gradient decreased from 59.0 ± 17.2 to 13.3 ± 13.6 mm Hg after the procedure (P < 0.01). Only one patient who refused stenting experienced a TIA event in the ipsilateral MCA territory. No recurrent ischemic event was observed in other patients.
Conclusion:
Mean trans-stenotic pressure gradients can be safely and easily measured with a 0.014-inch fluid-filled guide wire in intracranial large arteries. © 2016 Wiley Periodicals, Inc.
Related Concept Videos
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:23Assessment of blood pressure in brachial artery(two-step method)
01:15Assessment of blood pressure in brachial artery(one-step method)
Prepare for the Procedure:
01:21Sites for measuring blood pressure
The Brachial Artery: Primary Site for Blood Pressure Measurement