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Angiography‑based quantitative flow ratio for functional assessment of intracranial atherosclerotic disease
Kangmo Huang1, Haotao Li2, Shengxian Tu3
1Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Insights
Quantitative flow ratio (QFR) effectively identifies symptomatic intracranial atherosclerotic stenosis (ICAS), outperforming traditional stenosis measurements. A novel risk model using QFR aids in stratifying patients with ICAS for better stroke prevention.
Area of Science:
- Neuroscience
- Cardiovascular Research
- Medical Imaging
Background:
- Intracranial atherosclerotic stenosis (ICAS) is a significant cause of stroke with high recurrence rates.
- Accurate assessment of ICAS functional significance is crucial for personalized treatment and improved outcomes.
- Current methods may not fully capture the hemodynamic impact of ICAS.
Purpose of the Study:
- To evaluate the hemodynamic significance of ICAS using quantitative flow ratio (QFR).
- To develop and validate a risk stratification model for ICAS patients.
- To compare the diagnostic performance of QFR against traditional stenosis measurements.
Main Methods:
- Retrospective enrollment of patients with moderate to severe middle cerebral artery stenosis.
- Hemodynamic assessment using Murray law-based quantitative flow ratio (μQFR).
- Development and validation of multivariate logistic regression models and a nomogram incorporating μQFR and conventional risk factors.
Main Results:
- Symptomatic lesions were identified in 76.0% of 412 eligible patients.
- μQFR demonstrated superior discrimination of culprit lesions compared to angiographic stenosis severity (AUC 0.726 vs 0.631).
- The μQFR-inclusive model showed improved performance in risk stratification (AUC 0.850) with good calibration and discrimination.
Conclusions:
- μQFR is significantly associated with symptomatic ICAS and superior to stenosis severity in identification.
- The developed nomogram effectively discriminates symptomatic lesions in ICAS patients.
- This μQFR-based nomogram may serve as a valuable tool for ICAS patient risk stratification.
Background:
Intracranial atherosclerotic stenosis (ICAS), an important cause of stroke, is associated with a considerable stroke recurrence rate despite optimal medical treatment. Further assessment of the functional significance of ICAS is urgently needed to enable individualised treatment and, thus, improve patient outcomes.
Aims:
We aimed to evaluate the haemodynamic significance of ICAS using the quantitative flow ratio (QFR) technique and to develop a risk stratification model for ICAS patients.
Methods:
Patients with moderate to severe stenosis of the middle cerebral artery, as shown on angiography, were retrospectively enrolled. For haemodynamic assessment, the Murray law-based QFR (μQFR) was performed on eligible patients. Multivariate logistic regression models composed of μQFR and other risk factors were developed and compared for the identification of symptomatic lesions. Based on the superior model, a nomogram was established and validated by calibration.
Results:
Among 412 eligible patients, symptomatic lesions were found in 313 (76.0%) patients. The μQFR outperformed the degree of stenosis in discriminating culprit lesions (area under the curve [AUC]: 0.726 vs 0.631; DeLong test p-value=0.001), and the model incorporating μQFR and conventional risk factors also performed better than that containing conventional risk factors only (AUC: 0.850 vs 0.827; DeLong test p-value=0.034; continuous net reclassification index=0.620, integrated discrimination improvement=0.057; both p<0.001). The final nomogram showed good calibration (p for Hosmer-Lemeshow test=0.102) and discrimination (C-statistic 0.850, 95% confidence interval: 0.812-0.883).
Conclusions:
The μQFR was significantly associated with symptomatic ICAS and outperformed the angiographic stenosis severity. The final nomogram effectively discriminated symptomatic lesions and may provide a useful tool for risk stratification in ICAS patients.
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