Quantitative flow ratio for the functional assessment of extracranial internal carotid artery stenosis.

Minerva medica Pub Date : 2024-10-01 Epub Date: 2024-07-17 DOI:10.23736/S0026-4806.24.09350-9
Luigi DI Serafino, Eugenio Stabile, Giuseppe Giugliano, Raffaele Piccolo, Michele Franzese, Carlo Carbone, Lucia Mitrano, Maria L DE Rosa, Salvatore Esposito, Luca Bardi, Maria Scalamogna, Giovanni Esposito
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Abstract

Background: In asymptomatic patients presenting with significant internal carotid artery (ICA) stenoses undergoing endovascular revascularization, a selective angiography before stenting (CAS) is required. Sometimes, angiographic findings could be discordant from non-invasive assessment and a tool able to evaluate functional relevance of the stenosis could be of value. We sought to evaluate the usefulness of quantitative flow ratio (QFR) as angiography-based tool for functional assessment of ICA stenoses.

Methods: We prospectively enrolled 50 asymptomatic patients undergoing CAS. Peak systolic velocity (PSV, cm/s) assessed at color Doppler echocardiography was used to identify significant stenoses (PSV >125 cm/s). At angiography, assessment of ICA stenosis was obtained visually (%DSVISUAL) and according NASCET criteria (%DSNASCET). Stenoses were considered significant if >60%. After exclusion of 20 vessels, QFR, area stenosis (AS, %) and minimal lumen area (MLA, mm2) were obtained in the remaining 80 vessels.

Results: At linear regression analysis, QFR significantly correlated with PSV (r2=0.52, P<0.001) as well as with %DSNASCET (r2=0.68, P<0.001) and %DSVISUAL (r2=0.71, P<0.001). Using PSV as reference, QFR showed good accuracy to predict functionally significant stenosis (AUC=0.98, P<0.001) with a cut-off value of 0.93. As compared with %DSNASCET and %DSVISUAL, QFR showed a significantly higher accuracy (61% vs. 73% vs. 94%, respectively; P<0.05), sensitivity (43% vs. 61% vs. 93%, respectively; P<0.05) and negative predictive value (46% vs. 51% vs. 85%, respectively; P<0.05) for detecting hemodynamically significant ICA stenoses.

Conclusions: This study suggest the potential benefit of adopting QFR for functional assessment of extracranial ICA stenoses. These data should be validated in larger studies.

用于颅外颈内动脉狭窄功能评估的定量血流比值。
背景:无症状的颈内动脉(ICA)明显狭窄患者在接受血管内再通术时,需要在支架植入术(CAS)前进行选择性血管造影。有时,血管造影结果可能与非侵入性评估结果不一致,因此,一种能够评估狭窄功能相关性的工具可能很有价值。我们试图评估定量血流比(QFR)作为基于血管造影的 ICA 狭窄功能评估工具的实用性:我们对 50 名接受 CAS 手术的无症状患者进行了前瞻性研究。彩色多普勒超声心动图评估的峰值收缩速度(PSV,cm/s)用于识别明显的狭窄(PSV >125 cm/s)。在血管造影术中,以肉眼(%DSVISUAL)和 NASCET 标准(%DSNASCET)评估 ICA 狭窄程度。如果狭窄程度大于 60%,则视为严重狭窄。在排除 20 根血管后,获得了剩余 80 根血管的 QFR、狭窄面积(AS,%)和最小管腔面积(MLA,mm2):结果:在线性回归分析中,QFR 与 PSV(r2=0.52)、PNASCET(r2=0.68)、PVISUAL(r2=0.71)、PNASCET 和 %DSVISUAL 显著相关,QFR 显示出更高的准确性(分别为 61% vs. 73% vs. 94%;PConclusions:这项研究表明,采用 QFR 对颅外 ICA 狭窄进行功能评估具有潜在的益处。这些数据应在更大规模的研究中得到验证。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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