title: Severity assessment of intracranial large artery stenosis by pressure gradient measurements: A feasibility study.
abstract: BACKGROUND
  Fractional flow reserve (FFR)-guided revascularization strategy is popular in coronary intervention. However, the feasibility of assessing stenotic severity in intracranial large arteries using pressure gradient measurements still remains unclear.
  
  
  METHODS
  Between March 2013 and May 2014, 12 consecutive patients with intracranial large artery stenosis (including intracranial internal carotid artery, middle cerebral M1 segment, intracranial vertebral artery, and basilar artery) were enrolled in this study. The trans-stenotic pressure gradient was measured before and/or after percutaneous transluminal angioplasty and stenting (PTAS), and was then compared with percent diameter stenosis. A Pd /Pa cut-off of ≤0.70 was used to guide stenting of hemodynamically significant stenoses. The device-related and procedure-related serious adverse events and recurrent cerebral ischemic events were recorded.
  
  
  RESULTS
  The target vessel could be reached in all cases. No technical complications occurred due to the specific study protocol. Excellent pressure signals were obtained in all patients. For seven patients who performed PTAS, the mean pre-procedural pressure gradient decreased from 59.0 ± 17.2 to 13.3 ± 13.6 mm Hg after the procedure (P < 0.01). Only one patient who refused stenting experienced a TIA event in the ipsilateral MCA territory. No recurrent ischemic event was observed in other patients.
  
  
  CONCLUSIONS
  Mean trans-stenotic pressure gradients can be safely and easily measured with a 0.014-inch fluid-filled guide wire in intracranial large arteries. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China.
authors.forename: Yun-Fei
authors.initials: YF
authors.lastname: Han
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Wen-Hua
authors.initials: WH
authors.lastname: Liu
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Xiang-Liang
authors.initials: XL
authors.lastname: Chen
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Yun-Yun
authors.initials: YY
authors.lastname: Xiong
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Qin-
authors.initials: Q
authors.lastname: Yin
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Ge-Lin
authors.initials: GL
authors.lastname: Xu
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Wu-Sheng
authors.initials: WS
authors.lastname: Zhu
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Ren-Liang
authors.initials: RL
authors.lastname: Zhang
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Min-Min
authors.initials: MM
authors.lastname: Ma
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Min-
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Qi-Liang
authors.initials: QL
authors.lastname: Dai
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Wen-
authors.initials: W
authors.lastname: Sun
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: De-Zhi
authors.initials: DZ
authors.lastname: Liu
authors.affiliation: Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
authors.forename: Li-Hui
authors.initials: LH
authors.lastname: Duan
authors.affiliation: Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China.
authors.forename: Xin-Feng
authors.initials: XF
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D062186:Arterial Pressure; D001488:Basilar Artery / Q000503:physiopathology*; D001795:Blood Pressure Determination / Q000295:instrumentation; D002343:Carotid Artery, Internal / Q000503:physiopathology*; D002533:Cerebral Angiography; D003251:Constriction, Pathologic; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000503:physiopathology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D015607:Stents; D014160:Transducers, Pressure; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000503:physiopathology*
keywords: feasibility; intracranial large artery; physiologic assessment; stenosis