Journal article
Intracranial Atherosclerosis: A Disease of Functional, not Anatomic Stenosis? How Trans-Stenotic Pressure Gradients Can Help Guide Treatment
Operative neurosurgery (Hagerstown, Md.), Vol.18(6), pp.599-605
06/01/2020
DOI: 10.1093/ons/opz335
PMID: 31848612
Abstract
Abstract Background Most trials have assessed intracranial atherosclerotic disease (ICAD) severity based on angiographic stenosis. However, anatomic stenosis might not accurately identify the actual state of functional post-stenotic flow limitation. Objective To investigate whether angiographic stenosis correlates with physiologic distal flow limitation, measured as trans-stenotic pressure gradients, in ICAD patients. Methods In patients referred for endovascular treatment of anterior circulation symptomatic ICAD who failed maximal medical therapy (MMT) per SAMMPRIS (Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis) criteria, angiographic luminal diameters and percentages of stenosis were correlated with trans-stenotic pressure gradients, calculated as distal/proximal pressure ratios (DPPR) and proximal minus distal pressure gradients (PDPG), by way of Spearman correlation coefficients. Results Nine patients (3 men, 6 women) were evaluated. Atherosclerotic lesions’ locations included internal carotid artery in 5 subjects (2 cavernous, 3 supraclinoid) and proximal middle cerebral artery (M1) in 4 patients. Mean percentage of stenosis was 80 ± 8% (range 75%-94%). Minimal lumen diameter at the most stenotic ICAD site ranged from 0.2 to 0.9 mm (0.59 ± 0.41 mm). DPPR ranged from 0.38 to 0.63 (0.56 ± 0.14). PDPG ranged from 35 to 57 mm Hg (50 ± 8 mm Hg). Spearman coefficients showed no correlation between DPPR or PDPG and angiographic minimal luminal diameters or percentages of stenosis. There were no procedural complications related to trans-stenotic pressure measurements. CONCLUSION Angiographic stenosis does not reflect the physiologic severity of distal flow limitation in patients with ICAD. Hemodynamic assessment using trans-stenotic pressure ratios and gradients may serve as a more reliable predictive biomarker for MMT failure and response to revascularization.
Details
- Title: Subtitle
- Intracranial Atherosclerosis: A Disease of Functional, not Anatomic Stenosis? How Trans-Stenotic Pressure Gradients Can Help Guide Treatment
- Creators
- Mario Zanaty - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IowaJames D Rossen - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IowaJorge A Roa - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IowaDaichi Nakagawa - Department of Neurosurgery, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, JapanJoseph S Hudson - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IowaSami Al Kasab - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IowaKaustubh Limaye - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IowaKhaled Asi - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IowaSudeepta Dandapat - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IowaPascal Jabbour - Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PennsylvaniaEdgar A Samaniego - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IowaDavid M Hasan - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- Operative neurosurgery (Hagerstown, Md.), Vol.18(6), pp.599-605
- DOI
- 10.1093/ons/opz335
- PMID
- 31848612
- NLM abbreviation
- Oper Neurosurg (Hagerstown)
- ISSN
- 2332-4252
- eISSN
- 2332-4260
- Grant note
- 0
- Language
- English
- Date published
- 06/01/2020
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurology; Radiology; Iowa Neuroscience Institute; Cardiovascular Medicine; Neurosurgery; Otolaryngology; Internal Medicine
- Record Identifier
- 9984070264702771
Metrics
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