Vakharia Kunal, Waqas Muhammad, Fayyaz Najya, Young Amanda, Levy Elad I, Davies Jason M, Siddiqui Adnan H
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York.
Oper Neurosurg (Hagerstown). 2020 Sep 15;19(4):422-428. doi: 10.1093/ons/opaa058.
Instantaneous wave-free ratios (iFRs) are functional measures of arterial stenosis that have become essential to interventional cardiology procedures. Their use for intracranial submaximal angioplasty (angioplasty with an undersized balloon) has not been studied extensively.
To describe the feasibility and technique of iFR measurement for stenosis assessment during intracranial angioplasty.
We present a series of consecutive patients treated between January 1, 2017 and June 30, 2018 with submaximal intracranial angioplasty in whom pre- and postprocedure iFR measurements were obtained with a Verrata-Volcano pressure wire (Philips, Amsterdam, The Netherlands). We collected patient data on age, sex, comorbid conditions, presenting complaints, modified Rankin scale (mRS) score at admission, neurological findings, procedure duration, fluoroscopy time, intraprocedural complications, length of hospital stay, and mRS score at last clinical follow-up (favorable outcome, 0-2). Angiographic stenosis severity and iFR values were recorded before and after angioplasty.
A total of 12 patients underwent iFR-guided angioplasty during the study period. The median patient age was 69.5 yr (range 48-81 yr). All patients had symptomatic intracranial arterial stenosis (3-basilar, 2-vertebral, 6-middle cerebral, 1-internal carotid). Preangioplasty stenosis ranged from 55% to 90%. The median postangioplasty reduction in stenosis was 17% (range 9%-30%). Preangioplasty values ranged from 0.30 to 0.40 (n = 4). Postangioplasty values ranged from 0.6 to 0.9 (n = 5). iFR values improved considerably in all patients. No procedure-related complications occurred. The median follow-up was 8.9 mo (range 3-25 mo). Follow-up outcomes were favorable in 10 patients.
iFR measurement before and after intracranial angioplasty is feasible. It may be used to assess the adequacy of intracranial angioplasty.
瞬时无波比率（iFR）是动脉狭窄的功能指标，已成为介入心脏病学手术的重要指标。其在颅内次最大程度血管成形术（使用小号球囊进行的血管成形术）中的应用尚未得到广泛研究。
描述颅内血管成形术期间使用iFR测量评估狭窄的可行性和技术。
我们介绍了一系列在2017年1月1日至2018年6月30日期间接受次最大程度颅内血管成形术治疗的连续患者，这些患者在术前和术后使用Verrata-Volcano压力导丝（飞利浦，阿姆斯特丹，荷兰）进行了iFR测量。我们收集了患者的年龄、性别、合并症、主诉、入院时改良Rankin量表（mRS）评分、神经学检查结果、手术持续时间、透视时间、术中并发症、住院时间以及最后一次临床随访时的mRS评分（良好结局，0-2）等数据。记录血管成形术前和术后的血管造影狭窄严重程度和iFR值。
在研究期间，共有12例患者接受了iFR引导的血管成形术。患者的中位年龄为69.5岁（范围48-81岁）。所有患者均有症状性颅内动脉狭窄（3例基底动脉、2例椎动脉、6例大脑中动脉、1例颈内动脉）。血管成形术前狭窄范围为55%至90%。血管成形术后狭窄的中位减少率为17%（范围9%-30%）。血管成形术前的值范围为0.30至0.40（n = 4）。血管成形术后的值范围为0.6至0.9（n = 5）。所有患者的iFR值均有显著改善。未发生与手术相关的并发症。中位随访时间为8.9个月（范围3-25个月）。10例患者的随访结局良好。
颅内血管成形术前后进行iFR测量是可行的。它可用于评估颅内血管成形术的充分性。
