Instantaneous Wave-Free Ratio Measurement During Intracranial Submaximal Angioplasty: Case Series and 2-Dimensional Operative Video.
Fractional flow reserve
Instantaneous wave-free ratio
Intracranial atherosclerosis
Submaximal angioplasty
Journal
Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417
Informations de publication
Date de publication:
15 09 2020
15 09 2020
Historique:
received:
20
09
2019
accepted:
02
02
2020
pubmed:
7
5
2020
medline:
22
6
2021
entrez:
7
5
2020
Statut:
ppublish
Résumé
Instantaneous wave-free ratios (iFRs) are functional measures of arterial stenosis that have become essential to interventional cardiology procedures. Their use for intracranial submaximal angioplasty (angioplasty with an undersized balloon) has not been studied extensively. To describe the feasibility and technique of iFR measurement for stenosis assessment during intracranial angioplasty. We present a series of consecutive patients treated between January 1, 2017 and June 30, 2018 with submaximal intracranial angioplasty in whom pre- and postprocedure iFR measurements were obtained with a Verrata-Volcano pressure wire (Philips, Amsterdam, The Netherlands). We collected patient data on age, sex, comorbid conditions, presenting complaints, modified Rankin scale (mRS) score at admission, neurological findings, procedure duration, fluoroscopy time, intraprocedural complications, length of hospital stay, and mRS score at last clinical follow-up (favorable outcome, 0-2). Angiographic stenosis severity and iFR values were recorded before and after angioplasty. A total of 12 patients underwent iFR-guided angioplasty during the study period. The median patient age was 69.5 yr (range 48-81 yr). All patients had symptomatic intracranial arterial stenosis (3-basilar, 2-vertebral, 6-middle cerebral, 1-internal carotid). Preangioplasty stenosis ranged from 55% to 90%. The median postangioplasty reduction in stenosis was 17% (range 9%-30%). Preangioplasty values ranged from 0.30 to 0.40 (n = 4). Postangioplasty values ranged from 0.6 to 0.9 (n = 5). iFR values improved considerably in all patients. No procedure-related complications occurred. The median follow-up was 8.9 mo (range 3-25 mo). Follow-up outcomes were favorable in 10 patients. iFR measurement before and after intracranial angioplasty is feasible. It may be used to assess the adequacy of intracranial angioplasty.
Sections du résumé
BACKGROUND
Instantaneous wave-free ratios (iFRs) are functional measures of arterial stenosis that have become essential to interventional cardiology procedures. Their use for intracranial submaximal angioplasty (angioplasty with an undersized balloon) has not been studied extensively.
OBJECTIVE
To describe the feasibility and technique of iFR measurement for stenosis assessment during intracranial angioplasty.
METHODS
We present a series of consecutive patients treated between January 1, 2017 and June 30, 2018 with submaximal intracranial angioplasty in whom pre- and postprocedure iFR measurements were obtained with a Verrata-Volcano pressure wire (Philips, Amsterdam, The Netherlands). We collected patient data on age, sex, comorbid conditions, presenting complaints, modified Rankin scale (mRS) score at admission, neurological findings, procedure duration, fluoroscopy time, intraprocedural complications, length of hospital stay, and mRS score at last clinical follow-up (favorable outcome, 0-2). Angiographic stenosis severity and iFR values were recorded before and after angioplasty.
RESULTS
A total of 12 patients underwent iFR-guided angioplasty during the study period. The median patient age was 69.5 yr (range 48-81 yr). All patients had symptomatic intracranial arterial stenosis (3-basilar, 2-vertebral, 6-middle cerebral, 1-internal carotid). Preangioplasty stenosis ranged from 55% to 90%. The median postangioplasty reduction in stenosis was 17% (range 9%-30%). Preangioplasty values ranged from 0.30 to 0.40 (n = 4). Postangioplasty values ranged from 0.6 to 0.9 (n = 5). iFR values improved considerably in all patients. No procedure-related complications occurred. The median follow-up was 8.9 mo (range 3-25 mo). Follow-up outcomes were favorable in 10 patients.
CONCLUSION
iFR measurement before and after intracranial angioplasty is feasible. It may be used to assess the adequacy of intracranial angioplasty.
Identifiants
pubmed: 32372085
pii: 5830897
doi: 10.1093/ons/opaa058
pmc: PMC7490221
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
422-428Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR001413
Pays : United States
Informations de copyright
Copyright © 2020 by the Congress of Neurological Surgeons.
Références
Pflugers Arch. 2017 Jun;469(5-6):613-628
pubmed: 28353154
J Am Coll Cardiol. 2012 Mar 20;59(12):1045-57
pubmed: 22421298
N Engl J Med. 2011 Sep 15;365(11):993-1003
pubmed: 21899409
Stroke. 2011 Jan;42(1 Suppl):S20-3
pubmed: 21164126
J Am Coll Cardiol. 2013 Apr 2;61(13):1409-20
pubmed: 23500218
J Cereb Blood Flow Metab. 2011 May;31(5):1293-301
pubmed: 21157476
J Neurosurg. 2016 Oct;125(4):964-971
pubmed: 26745485
N Engl J Med. 2017 May 11;376(19):1813-1823
pubmed: 28317438
N Engl J Med. 2005 Mar 31;352(13):1305-16
pubmed: 15800226
Interv Neurol. 2016 Jun;5(1-2):65-75
pubmed: 27610123
N Engl J Med. 2009 Jan 15;360(3):213-24
pubmed: 19144937
Ann Neurol. 2011 Jun;69(6):963-74
pubmed: 21437932
N Engl J Med. 2014 Sep 25;371(13):1208-17
pubmed: 25176289
AJNR Am J Neuroradiol. 2014 Jun;35(6):1157-62
pubmed: 24676000
Neurosurgery. 2009 Dec;65(6):1024-33; discussion 1033-4
pubmed: 19934961
JAMA. 2015 Mar 24-31;313(12):1240-8
pubmed: 25803346