Wang Ming, Leng Xiaochang, Mao Baojie, Zou Rong, Lin Dongdong, Gao Yuhai, Wang Ning, Lu Yuning, Fiehler Jens, Siddiqui Adnan H, Wu Jiong, Xiang Jianping, Wan Shu
Brain Center, Zhejiang Hospital, Hangzhou, China.
ArteryFlow Technology Co., Ltd., Hangzhou, China.
Heliyon. 2023 Feb 10;9(2):e13527. doi: 10.1016/j.heliyon.2023.e13527. eCollection 2023 Feb.
Fractional flow reserve is widely used for the functional evaluation of coronary artery stenosis. Some studies have similarly used the translesional pressure ratio measurements for the functional evaluation of intracranial atherosclerotic stenosis. In this paper, we aimed to investigate the relationship between pressure ratio and cerebral tissue perfusion by MR perfusion imaging and provided a non-invasive method for evaluating the functional significance of intracranial atherosclerotic stenosis.
A total of 18 consecutive patients with intracranial atherosclerotic stenosis patients including 19 stenotic vessels were recruited. The pressure was measured using a pressure guidewire, the pressure ratio before and after the endovascular intervention was calculated and compared with the severity of diameter stenosis and perfusion-derived MR (the time to maximum tissure residue function (Tmax)). Moreover, the DSA-derived pressure ratio was computed using a novel computational fluid dynamics-based model, termed CFD-PR, and was compared with the actual pressure ratio to assess its diagnostic accuracy.
The pressure ratio increased after percutaneous transluminal angioplasty or stenting, while the correlation between pressure ratio and diameter stenosis was not significant. The pressure ratio was negatively correlated with Tmax (r = -0.73, P < 0.01), and a 95% confidence interval for the cutoff value of pressure ratio = 0.67 (95% confidence interval: 0.58-0.76) was suggested. There was a good correlation (mean = 0.02, Spearman's correlation coefficient r = 0.908, P < 0.001) and agreement (limits of agreement: -0.157 to 0.196, P = 0.954) between CFD-PR and the actual pressure ratio.
This exploratory study indicates the pressure ratio may correlate with the perfusion status. The pressure ratio can be calculated through a non-invasive method using a computational fluid dynamics-based method.
血流储备分数广泛用于冠状动脉狭窄的功能评估。一些研究同样使用跨病变压力比值测量来评估颅内动脉粥样硬化狭窄的功能。在本文中，我们旨在通过磁共振灌注成像研究压力比值与脑组织灌注之间的关系，并提供一种无创方法来评估颅内动脉粥样硬化狭窄的功能意义。
连续纳入18例颅内动脉粥样硬化狭窄患者，共19条狭窄血管。使用压力导丝测量压力，计算血管内介入前后的压力比值，并与直径狭窄程度和灌注衍生磁共振成像（最大组织残留函数时间（Tmax））进行比较。此外，使用一种基于计算流体动力学的新型模型（称为CFD-PR）计算数字减影血管造影（DSA）衍生的压力比值，并与实际压力比值进行比较以评估其诊断准确性。
经皮腔内血管成形术或支架置入术后压力比值升高，而压力比值与直径狭窄之间的相关性不显著。压力比值与Tmax呈负相关（r = -0.73，P < 0.01），建议压力比值截断值的95%置信区间为0.67（95%置信区间：0.58 - 0.76）。CFD-PR与实际压力比值之间存在良好的相关性（平均值 = 0.02，Spearman相关系数r = 0.908，P < 0.001）和一致性（一致性界限：-0.157至0.196，P = 0.954）。
这项探索性研究表明压力比值可能与灌注状态相关。压力比值可以通过基于计算流体动力学的无创方法计算得出。
