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Published on: January 18, 2018
Post-thrombectomy angiography-derived fractional flow is associated with functional outcomes in ICAS-related large
Yi-Ning Yang1, Tingyu Yi1, Jinfeng Miao2
1Cerebrovascular and Neuro-Intervention Department, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, Fujian, China.
Insights
Higher fractional flow (FF) after thrombectomy for intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusion (LVO) predicts better functional independence. This physiologic marker may be more significant than anatomic stenosis measures for predicting outcomes.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Optimal management of residual stenosis post-thrombectomy for intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusion (LVO) is unclear.
- This study investigates the association between post-thrombectomy fractional flow (FF) and 90-day functional independence in anterior circulation ICAS-LVO.
Purpose of the Study:
- To evaluate if post-thrombectomy FF predicts 90-day functional independence in anterior circulation ICAS-LVO.
- To compare the predictive performance of FF against traditional anatomic stenosis measures.
Main Methods:
- Retrospective analysis of a prospectively maintained registry of patients with anterior circulation ICAS-LVO undergoing successful thrombectomy.
- Fractional flow (FF) computed using AccuICAD V1.0 software; optimal FF cut-off determined by ROC analysis (≤0.94 for low-FF, >0.94 for high-FF).
- Multivariable logistic regression and ROC analyses used to assess the association of FF with functional independence (modified Rankin Scale score ≤2).
Main Results:
- Higher FF was significantly associated with 90-day functional independence (84.2% in high-FF vs. 45.8% in low-FF, P<0.001).
- High FF remained an independent predictor of functional independence after full adjustment (OR, 4.46; P=0.008).
- Fractional flow demonstrated superior predictive discrimination compared to diameter and area stenosis rates (AUC 0.761 vs. 0.657 vs. 0.660).
Conclusions:
- Elevated post-thrombectomy FF is linked to improved 90-day functional outcomes in anterior circulation ICAS-LVO.
- FF may serve as a valuable physiologic marker for assessing residual lesion significance after thrombectomy.
- Further research is warranted to validate these findings.
Background:
Optimal management of residual stenosis after successful thrombectomy in intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusion (LVO) remains uncertain. We evaluated whether post-thrombectomy angiography-derived fractional flow (FF) was associated with 90-day functional independence in anterior circulation ICAS-LVO and whether FF outperformed anatomic stenosis measures.
Materials And Methods:
This retrospective analysis of a prospectively maintained registry included consecutive patients with anterior circulation ICAS-LVO who achieved successful reperfusion after thrombectomy between October 2024 and June 2025. Post-thrombectomy FF was computed using AccuICAD V1.0 software. Receiver operating characteristic analysis with the maximum Youden index identified the optimal FF cut-off for predicting 90-day functional independence, defined as a modified Rankin Scale (mRS) score ≤2. Patients were dichotomized into two groups: a low-FF (FF ≤0.94) group and a high-FF (FF >0.94) group. Multivariable logistic regression and receiver operating characteristic analyses were performed.
Results:
Among 105 patients (mean age, 66 years±11; 81 men), 90-day functional was observed in 22 of 48 patients (45.8%) in the low-FF group and 48 of 57 patients (84.2%) in the high-FF group (P<0.001). After full adjustment, high-FF remained independently associated with functional independence (OR, 4.46; 95% CI: 1.5-13.3; P=0.008). FF showed better discrimination than diameter and area stenosis rate (area under the curve (AUC) 0.761 vs 0.657 vs 0.660, respectively; P=0.03 and P=0.04).
Conclusion:
Higher post-thrombectomy FF was associated with better 90-day outcomes in anterior circulation ICAS-LVO and may provide a physiologic marker of residual lesion significance. Further validation is needed.