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Prognostic value of angiographic based quantitative flow ratio and anatomic features in intracranial atherosclerotic
Kangmo Huang1, Weihe Yao1, Zhiruo Song2
1Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Insights
Intracranial atherosclerotic stenosis (ICAS) patients face high stroke recurrence. Angiography-based quantitative flow ratio (μQFR) and lesion location predict 5-year outcomes, aiding personalized treatment for ICAS.
Area of Science:
- Neurology
- Cardiovascular Research
- Medical Imaging
Background:
- Intracranial atherosclerotic stenosis (ICAS) poses a significant risk for recurrent stroke, even with optimal medical management.
- Individualized therapeutic strategies for ICAS necessitate a deeper understanding of its anatomical and physiological underpinnings.
- Current assessment methods may not fully capture the hemodynamic complexities contributing to stroke risk in ICAS patients.
Purpose of the Study:
- To evaluate the predictive capability of angiography-derived hemodynamic and anatomical features for stroke recurrence in patients with ICAS.
- To explore the utility of quantitative flow ratio (μQFR) and lesion characteristics in stratifying stroke risk.
- To identify key prognostic indicators for guiding personalized treatment approaches in ICAS.
Main Methods:
- A retrospective analysis of 333 patients with moderate-to-severe middle cerebral artery (MCA) stenosis.
- Hemodynamic assessment using single-view quantitative flow ratio (μQFR) derived from angiography.
- Lesion categorization based on location (perforator-rich MCA segments [pMCA] vs. others) and multivariate Cox models for predictor identification.
Main Results:
- Over a median follow-up of 64.5 months, 15.0% of patients experienced primary outcomes (stroke/TIA), with 80% occurring within 5 years.
- Lower μQFR values (<0.73) were associated with a higher risk of 5-year primary outcomes (P=0.023).
- Multivariate analysis identified lower μQFR (aHR=0.345), pMCA location (aHR=0.377), and internal carotid artery diameter ratio (aHR=4.187) as significant predictors of 5-year outcomes.
Conclusions:
- Angiography-based quantitative flow ratio (μQFR) shows promise as a prognostic index for MCA atherosclerosis.
- Plaque localization within the pMCA and internal carotid artery expansion are significant anatomical predictors of stroke risk.
- These findings support the use of advanced imaging parameters for risk stratification and personalized therapy in ICAS.
Background:
Patients with intracranial atherosclerotic stenosis (ICAS) are prone to stroke recurrence despite aggressive medical treatment. Further assessment of the anatomy and physiology of ICAS is urgently needed to facilitate individualized therapy. We explored the predictive value of angiography based hemodynamic and anatomical features for ICAS patients.
Methods:
In this retrospective study, patients with moderate-to-severe stenosis of the middle cerebral artery (MCA) were enrolled. The hemodynamic assessment was performed using the single view Murray's law based quantitative flow ratio (μQFR) approach. The locations of lesions were categorized as perforator rich segments of the MCA (pMCA) and others. Multivariate Cox models were developed to identify significant predictors. The primary outcomes were defined as stroke and transient ischemic attack.
Results:
Among the 333 patients (median (IQR) age, 56 (49-63) years, 70.3% men) over a median follow-up period of 64.5 months, 50 (15.0%) had the primary outcomes, and 80.0% occurred within 5 years. Patients with lower μQFR values (dichotomized at 0.73) had a higher risk of the 5 year primary outcomes (log rank P=0.023), and good collateral circulation may have attenuated the risk. In the multivariate analyses, μQFR (adjusted HR=0.345; 95% CI 0.155 to 0.766; P=0.009), lesion located in pMCA (adjusted HR=0.377; 95% CI 0.190 to 0.749; P=0.005), and diameter ratio of the internal carotid artery (adjusted HR=4.187; 95% CI 1.071 to 16.370; P=0.040) were significantly associated with the 5 year primary outcomes.
Conclusions:
Angiography based μQFR and anatomical features, namely plaque localization and internal carotid artery expansion, could serve as promising prognostic indexes for MCA atherosclerosis.
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