Intracranial Atherosclerosis: A Disease of Functional, not Anatomic Stenosis? How Trans-Stenotic Pressure Gradients Can Help Guide Treatment.

摘要: Background Most 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. Objective To investigate whether correlates with physiologic distal limitation, measured as trans-stenotic pressure gradients, in ICAD patients. Methods In patients referred for endovascular treatment anterior circulation symptomatic who failed maximal medical therapy (MMT) per SAMMPRIS (Stenting versus Aggressive Medical Therapy Intracranial Arterial Stenosis) criteria, luminal diameters and percentages were correlated calculated distal/proximal ratios (DPPR) proximal minus gradients (PDPG), by way Spearman correlation coefficients. Results Nine (3 men, 6 women) evaluated. Atherosclerotic lesions' locations included internal carotid artery 5 subjects (2 cavernous, 3 supraclinoid) middle cerebral (M1) 4 Mean percentage was 80 ± 8% (range 75%-94%). Minimal lumen diameter at most stenotic site ranged from 0.2 to 0.9 mm (0.59 0.41 mm). DPPR 0.38 0.63 (0.56 0.14). PDPG 35 57 Hg (50 8 Hg). coefficients showed no between or minimal There procedural complications related measurements. Conclusion Angiographic does reflect limitation ICAD. Hemodynamic assessment using may serve a more reliable predictive biomarker MMT failure response revascularization.