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
{"title":"Quantitative flow ratio for the functional assessment of extracranial internal carotid artery stenosis.","authors":"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","doi":"10.23736/S0026-4806.24.09350-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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 (%DS<inf>VISUAL</inf>) and according NASCET criteria (%DS<inf>NASCET</inf>). Stenoses were considered significant if >60%. After exclusion of 20 vessels, QFR, area stenosis (AS, %) and minimal lumen area (MLA, mm<sup>2</sup>) were obtained in the remaining 80 vessels.</p><p><strong>Results: </strong>At linear regression analysis, QFR significantly correlated with PSV (r<sup>2</sup>=0.52, P<0.001) as well as with %DS<inf>NASCET</inf> (r<sup>2</sup>=0.68, P<0.001) and %DS<inf>VISUAL</inf> (r<sup>2</sup>=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 %DS<inf>NASCET</inf> and %DS<inf>VISUAL</inf>, 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.</p><p><strong>Conclusions: </strong>This study suggest the potential benefit of adopting QFR for functional assessment of extracranial ICA stenoses. These data should be validated in larger studies.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Minerva medica","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.23736/S0026-4806.24.09350-9","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/17 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

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。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信