Hemodynamic Assessment of Intracranial Atherosclerotic Stenosis Using Angiographic Images: Correlation with In-Stent
Lijun Wang1, Xiangjun Xiao1, Yuhao Tan1
1From the Neurovascular Center (L.W., X.X., Y.T., L.Q., X. Zhang, Yongxin Zhang, X. Zhu, P.X., Z.L., R.Z., Yongwei Zhang, L.Z., P.Y., J.L.), Changhai Hospital, Naval Medical University, Shanghai, China.
Insights
Immediately postoperative Angio-FF effectively predicts in-stent restenosis (ISR) in intracranial atherosclerotic stenosis (ICAS) patients. This novel technique provides valuable intraoperative insights for assessing stenting success.
Area of Science:
- Cardiovascular Research
- Neurology
- Medical Imaging
Background:
- Cerebral hemodynamics are crucial for managing intracranial atherosclerotic stenosis (ICAS).
- Assessing hemodynamics in ICAS patients is clinically significant.
- Current methods may have limitations in evaluating hemodynamic changes post-intervention.
Purpose of the Study:
- To evaluate the clinical applicability of Angio-FF, a novel non-invasive technique for calculating fractional flow (FF) from cerebral angiography.
- To assess the correlation between Angio-FF and in-stent restenosis (ISR) in patients with ICAS.
- To determine if Angio-FF can reflect hemodynamic changes indicative of ISR.
Main Methods:
- 54 severe ICAS patients undergoing cerebral angiography were studied.
- Preoperative and immediate postoperative Angio-FF values were collected and compared.
- Receiver-operating characteristic (ROC) curve analysis evaluated Angio-FF's predictive efficacy for ISR after 6-month follow-up.
Main Results:
- No significant pre-operative hemodynamic differences between ISR and non-ISR groups.
- Postoperative degree of stenosis (DS)% was significantly higher in the ISR group (P<0.001).
- Postoperative Angio-FF was significantly lower in the ISR group (0.84 vs. 0.94, P=0.007), with an AUC of 0.785 for ISR prediction.
Conclusions:
- Immediately postoperative Angio-FF is an effective predictor of ISR in ICAS patients.
- Angio-FF provides valuable intraoperative information for assessing stenting effectiveness.
- This technique aids in managing patients with ICAS undergoing endovascular treatment.
Background And Purpose:
Cerebral hemodynamics hold profound clinical significance in the comprehensive management of intracranial atherosclerotic stenosis (ICAS). We have developed Angio-FF, a novel noninvasive fractional flow (FF) calculation technique derived from cerebral angiography, for evaluating hemodynamics in patients with ICAS. This study aims to evaluate the clinical applicability of Angio-FF in reflecting cerebral hemodynamics by assessing its correlation with in-stent restenosis (ISR) in patients with ICAS.
Materials And Methods:
A total of 54 patients with severe ICAS who had undergone cerebral angiography were recruited in the study between January 2019 and September 2022. For each patient, both preoperative and immediate postoperative Angio-FF values were collected and compared. During the 6-month follow-up, 9 patients were confirmed to have developed ISR. Receiver-operating characteristic curve (ROC) analysis was performed to evaluate the predictive efficacy of immediate postoperative Angio-FF value in differentiating between ISR and non-ISR.
Results:
No statistically significant disparities were detected in preoperative morphologic and hemodynamic between ISR and non-ISR groups. However, the immediately postoperative degree of stenosis% was significantly different between the ISR and non-ISR groups (26 [22-33] versus 10 [0-20]; P < .001). The postoperative Angio-FF value in the ISR group was markedly lower than that in the non-ISR group (0.84 [0.81-0.90] versus 0.94 [0.87-0.97]; P = .007). ROC analysis was performed to assess the predictive value of postoperative Angio-FF for ISR (area under the curve = 0.785; 95% CI, 0.647-0.923), with a cutoff value of 0.845.
Conclusions:
This study reveals that immediately postoperative Angio-FF is an effective predictor of ISR, providing valuable intraoperative information for assessing the effectiveness of stent placement in patients with ICAS.
