Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
J Neurointerv Surg. 2020 Dec;12(12):1248. doi: 10.1136/neurintsurg-2020-016080. Epub 2020 Jul 22.
Angiographic stenosis may not be an accurate reflection of physiological flow limitation. Measurement of instant flow reserve (IFR) to quantify functional flow limitation across stenosis may be valuable in identifying lesions causing significant flow limitation. A case of left middle cerebral artery atherosclerotic disease is presented. Because medical therapy had failed, endovascular revascularization was chosen. In this video 1, IFR measurement to guide submaximal balloon angioplasty with a 1.5×9 mm non-compliant Mini-Trek balloon (Abbott) is demonstrated. Pressure gradient across the middle cerebral artery-M1 stenosis was measured with a Volcano pressure wire (Philips) before and after submaximal balloon angioplasty. An excellent radiographic result and flow improvement into the severely stenosed segment were achieved, with an IFR increase from 0.23 to 0.89. The degree of corresponding stenosis changed from 85% to 30%. No periprocedural complication was observed. IFR can help to identify lesions requiring treatment in select patients and prevent the tendency to overtreat a lesion that is not physiologically significant.
血管造影狭窄可能无法准确反映生理血流受限。测量即时血流储备（IFR）来量化狭窄处的功能性血流受限可能有助于识别导致明显血流受限的病变。本文介绍了一例左侧大脑中动脉粥样硬化性疾病患者。由于药物治疗失败，选择了血管内血运重建。在本视频 1 中，演示了使用 1.5×9mm 非顺应性 Mini-Trek 球囊（雅培）进行亚最大球囊扩张时测量 IFR 以指导治疗。在进行亚最大球囊扩张前后，使用 Volcano 压力导丝（飞利浦）测量大脑中动脉-M1 狭窄处的压力梯度。实现了出色的影像学结果和严重狭窄段的血流改善，IFR 从 0.23 增加到 0.89。相应狭窄程度从 85%变为 30%。未观察到围手术期并发症。IFR 可帮助识别需要在特定患者中治疗的病变，并防止过度治疗在生理上不重要的病变的趋势。
