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Updated: Jul 3, 2026
Dynamic Assessments of Coronary Flow Reserve after Myocardial Ischemia Reperfusion in Mice
Published on: August 25, 2023
CT - derived fractional flow reserve can predict recurrent ischemia in patients with MCA stenosis
Zhuhao Yin1, Tongyuan Liu1, Changsheng Zhou2
1Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Rationale And Objectives:
CT-derived fractional flow reserve (CT-FFR) has rarely been used to evaluate the hemodynamic changes of cerebral arterial stenosis. We aimed to investigate the role of CT-FFR in predicting recurrent ischemic risk in patients with symptomatic middle cerebral artery (MCA) stenosis.
Materials And Methods:
124 eligible patients with unilateral MCA stenosis undergoing four-dimensional CTA were retrospectively included. Computational fluid dynamics model was reconstructed from the peak arterial phase CTA to calculate CT-FFR. MTT > 6.5 s was defined as cerebral hypoperfusion. Recurrent ischemic event within 1 year was recorded.
Results:
Of 124 patients, 19 had recurrent ischemic event, with lower CT-FFR value than non-recurrent ischemia group (median 0.72 vs. 0.83, p = 0.02). The cerebral hypoperfusion-specific CT-FFR cut-off value of 0.80 was independently associated with recurrent ischemic event (adjusted hazard ratio, 2.97 [95%CI: 1.32, 7.14]; p = 0.03). CT-FFR provided improved prognostic value beyond DS alone with the area under the curve value upon leave-one-out cross-validation (0.72 [95%CI: 0.64, 0.80] vs. 0.66 [95%CI: 0.57, 0.74]; p = 0.001), C-index (0.704 [95%CI: 0.613, 0.795] vs. 0.648 [95%CI: 0.573, 0.723]; p = 0.002) and categorical net reclassification improvement index (0.264 [95%CI: 0.096, 0.479]; p = 0.03).
Conclusion:
A CT-FFR threshold specific to CTP-based hypoperfusion may achieve improved value compared to DS alone for predicting recurrent ischemic event within 1 year in patients with symptomatic MCA stenosis.
