Noninvasive fractional flow in intracranial atherosclerotic stenosis: Reproducibility, limitations, and perspectives

Background and purpose: Fractional flow reserve (FFR) has exceled the degree of stenosis and become the new guiding post for identifying functionally severe coronary artery lesions. In the current study, we utilized a similar indicator, fractional flow (FF), to gauge the hemodynamic impact of symptomatic intracranial atherosclerotic stenosis (ICAS), and to clarify its relationships with the severity of stenosis and collateral status. Methods: Patients with symptomatic ICAS (70-99% stenosis) confirmed on digital subtraction angiography (DSA) were consecutively recruited. FF was obtained during DSA examination, defined as the ratio of pressures measured distal to an ICAS lesion (Pd) and within the aorta (Pa), by pressure sensors. Leptomeningeal collaterals was grading from zero (absent) to four (complete compensatory) based on DSA examination. The correlations between FF, anatomical stenosis and collateral status were analyzed. Results: Twenty five patients with a mean age of 55.6years were included. The median percentage of stenosis and median FF were 82.3% and 0.68, respectively. Eleven patients were evaluated as poor collaterals (grade 0-2), and fourteen patients were good collaterals (grade 3-4). Overall, the hemodynamic impact of the lesions aggravated (with a decreased FF) as the percentage of stenosis increased (r= -0.398,P =0.06). However, the collateral status significantly altered such correlation, which was more significant in patients with poor collateral circulation (r=-0.677, P=0.032), but did not exist in patients with good collateral circulation (r=-0.279, P=0.356). Conclusions: An anatomically severe (70-99%) symptomatic ICAS lesion may lay significant hemodynamic stress downstream as assessed by the indicator FF. However, a good collateral circulation may mitigate such hemodynamic impact, which may partly explain the protective effect of good collaterals against recurrent stroke in such patients.

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Periprocedural risk and long-term outcome of intracranial angioplasty based on a single-centre experience

VASA ◽

10.1024/0301-1526/a000287 ◽

2013 ◽

Vol 42 (4) ◽

pp. 264-274

Author(s):

Dagmar Krajíčková ◽

Antonín Krajina ◽

Miroslav Lojík ◽

Martina Mulačová ◽

Martin Vališ

Keyword(s):

Death Rate ◽

Long Term Outcomes ◽

Single Centre ◽

Intracranial Atherosclerotic Stenosis ◽

Atherosclerotic Stenosis ◽

Angioplasty And Stenting ◽

Aggressive Medical Management ◽

Stroke Death

Background: Intracranial atherosclerotic stenosis is a major cause of stroke and yet there are currently no proven effective treatments for it. The SAMMPRIS trial, comparing aggressive medical management alone with aggressive medical management combined with intracranial angioplasty and stenting, was prematurely halted when an unexpectedly high rate of periprocedural events was found in the endovascular arm. The goal of our study is to report the immediate and long-term outcomes of patients with ≥ 70 % symptomatic intracranial atherosclerotic stenosis treated with balloon angioplasty and stent placement in a single centre. Patients and methods: This is a retrospective review of 37 consecutive patients with 42 procedures of ballon angioplasty and stenting for intracranial atherosclerotic stenosis (≥ 70 % stenosis) treated between 1999 and 2012. Technical success (residual stenosis ≤ 50 %), periprocedural success (no vascular complications within 72 hours), and long-term outcomes are reported. Results: Technical and periprocedural success was achieved in 90.5 % of patients. The within 72 hours periprocedural stroke/death rate was 7.1 % (4.8 % intracranial haemorrhage), and the 30-day stroke/death rate was 9.5 %. Thirty patients (81 %) had clinical follow-up at ≥ 6 months. During follow-up, 5 patients developed 6 ischemic events; 5 of them (17 %) were ipsilateral. The restenosis rate was 27 %, and the retreatment rate was 12 %. Conclusions: Our outcomes of the balloon angioplasty/stent placement for intracranial atherosclerotic stenosis are better than those in the SAMMPRIS study and compare favourably with those in large registries and observational studies.

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Symptomatic and asymptomatic intracranial atherosclerotic stenosis: 3 years’ prospective study

Journal of Neurology ◽

10.1007/s00415-020-09750-2 ◽

2020 ◽

Vol 267 (6) ◽

pp. 1687-1698 ◽

Cited By ~ 2

Author(s):

Urs Fischer ◽

Kety Hsieh-Meister ◽

Frauke Kellner-Weldon ◽

Aikaterini Galimanis ◽

Xin Yan ◽

...

Keyword(s):

Prospective Study ◽

Intracranial Atherosclerotic Stenosis ◽

Atherosclerotic Stenosis

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Safety and efficacy of the Low-Profile Visualized Intraluminal Support stent in treating intracranial atherosclerotic stenosis

Neurología ◽

10.1016/j.nrl.2021.02.013 ◽

2021 ◽

Author(s):

J.-W. Wang ◽

X.-Y. Li ◽

C.-H. Li ◽

J.-F. Liu ◽

H. Li ◽

...

Keyword(s):

Safety And Efficacy ◽

Intracranial Atherosclerotic Stenosis ◽

Atherosclerotic Stenosis ◽

Low Profile

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Decision letter for "Cerebral autoregulation is heterogeneous in different stroke mechanism of ischemic stroke caused by intracranial atherosclerotic stenosis"

10.1002/brb3.1907/v2/decision1 ◽

2020 ◽

Keyword(s):

Ischemic Stroke ◽

Cerebral Autoregulation ◽

Intracranial Atherosclerotic Stenosis ◽

Atherosclerotic Stenosis ◽

Stroke Mechanism

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Decision letter for "Cerebral autoregulation is heterogeneous in different stroke mechanism of ischemic stroke caused by intracranial atherosclerotic stenosis"

10.1002/brb3.1907/v1/decision1 ◽

2020 ◽

Keyword(s):

Ischemic Stroke ◽

Cerebral Autoregulation ◽

Intracranial Atherosclerotic Stenosis ◽

Atherosclerotic Stenosis ◽

Stroke Mechanism

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Abstract P230: Markers of Hyperglycemia and Intracranial Atherosclerotic Stenosis by Magnetic Resonance Angiography

Circulation ◽

10.1161/circ.133.suppl_1.p230 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Akira Fujiyoshi ◽

M.Fareed K Suri ◽

Alvaro Alonso ◽

Elizabeth Selvin ◽

Haitao Chu ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Atherosclerosis Risk In Communities ◽

Intracranial Atherosclerotic Stenosis ◽

Atherosclerotic Stenosis ◽

History Of ◽

Diagnosed Diabetes ◽

Aric Study

Introduction: Intracranial atherosclerotic stenosis (ICAS) is a common cause of stroke. Determinants of ICAS include conventional cardiovascular (CV) risk factors such as hypertension and dyslipidemia. The association of diabetes mellitus (DM) and/or hyperglycemia with ICAS, however, is less well documented. Hypothesis: In a community-based population, biomarkers of hyperglycemia will be cross-sectionally associated with prevalent ICAS independent of CV risk factors. Methods: Our analyses were conducted in a subsample of participants of the Atherosclerosis Risk in Communities (ARIC) Study who participated in the ARIC-Neurocognitive Study in 2011-13 with cerebrovascular magnetic resonance angiography and no history of stroke. For the present analyses, we grouped the participants into 3 categories based on the highest ICAS category among any of the intracranial arteries we assessed: “no stenosis”, “<50%”, or “≥50% (including occlusion)”. Diagnosed diabetes was defined as self-reported physician diagnosis or use of antidiabetic medication. Ordinal logistic regression provided odds ratios of prevalent ICAS according to quintile of glucose or glycated hemoglobin (HbA1c) adjusted for CV risk factors. Results (Table): There were 1,658 individuals included in our study (age 67-90 years, women 58%, Black 29%), 31% (514/1658) had diagnosed diabetes, 10% (165/1658) had ≥50 % stenosis at any of the intracerebral arteries. In crude analyses, those with higher glucose and HbA1c were more likely to have ICAS among the non-diabetes and the diabetes. In logistic regression, highest quintile of glucose, relative to the lowest, had odds ratio of 2.26 (95% confidence interval 1.48, 3.45) for being in each successive ICAS category after adjustment for CV risk factors. Conclusion: Higher glucose and HbA1c were associated with higher odds of ICAS independent of CV risk factors. The finding suggests that hyperglycemia plays a role in pathogenesis of ICAS.

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