ArticleOperative neurosurgery (Hagerstown, Md.)2020
Intracranial Atherosclerosis: A Disease of Functional, not Anatomic Stenosis? How Trans-Stenotic Pressure Gradients Can Help Guide Treatment.
Article in Operative neurosurgery (Hagerstown, Md.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 20 citations in OpenAlex.
- Assessing the Functional Severity of Carotid Artery Stenosis Using an Image-Based Hemodynamic Modeling Method.Annals of biomedical engineering · 2026Article
- Non-Invasive functional assessment of severity in cerebral arterial stenosis using cerebral flow fraction: A hemodynamic study.Medical & biological engineering & computing · 2026Article
- Article
- A Novel Method for Functional Assessment of the Stenosis of the Anterior Cerebral Circulation.Annals of biomedical engineering · 2025Article
- CTA and DSA based computational fluid dynamics models for morphological and hemodynamic assessment of intracranial atherosclerotic stenosis.Frontiers in neurology · 2025Article
- Integrating hemodynamic analysis with traditional imaging in intracranial atherosclerotic stenosis: current status and future perspectives.Frontiers in neurology · 2025Review
- New evidence for fractional pressure ratio prediction by pulsatility index from transcranial Doppler in patients with symptomatic cerebrovascular stenosis disease.Quantitative imaging in medicine and surgery · 2024Article
- Cerebral haemodynamics in symptomatic intracranial atherosclerotic disease: a narrative review of the assessment methods and clinical implications.Stroke and vascular neurology · 2023Review
- Cerebral hemodynamics in symptomatic anterior circulation intracranial stenosis measured by angiography-based quantitative flow ratio: association with CT perfusion.European radiology · 2023Article
- Sub-satisfactory recanalization of severe middle cerebral artery stenoses can significantly improve hemodynamics.Frontiers in cardiovascular medicine · 2022Article
- Hemodynamic Versus Anatomic Assessment of Symptomatic Atherosclerotic Middle Cerebral Artery Stenosis: the Relationship Between Pressure Wire Translesional Gradient and Angiographic Lesion Geometry.Frontiers in neurology · 2021Article
- CT - derived fractional flow reserve can predict recurrent ischemia in patients with MCA stenosis.Frontiers in neurologyArticle
- Prognosis of ischemia recurrence in patients with moderate intracranial atherosclerotic disease using quantitative MRA measurements.Proceedings of SPIE--the International Society for Optical EngineeringArticle
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Authors and funding
12 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundMost 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.
objectiveTo investigate whether angiographic stenosis correlates with physiologic distal flow limitation, measured as trans-stenotic pressure gradients, in ICAD patients.
methodsIn 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.
resultsNine 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.
conclusionAngiographic 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.
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