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.