Frontiers in neurology · 2026
CT - derived fractional flow reserve can predict recurrent ischemia in patients with MCA stenosis.
СтатьяНазвание и аннотация: Перевод в очереди
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Yin Zhuhao, Liu Tongyuan, Zhou Changsheng, Guo Jian, Wei Yuan, Ma Yifei, Zhou Fan, Zhu Wusheng, Cheng Xiaoqing, Zhang Long Jiang
Аннотация
RATIONALE AND OBJECTIVES: CT-derived fractional flow reserve (CT-FFR) has rarely been used to evaluate the hemodynamic changes of cerebral arterial stenosis. We aimed to investigate the role of CT-FFR in predicting recurrent ischemic risk in patients with symptomatic middle cerebral artery (MCA) stenosis.
MATERIALS AND METHODS: 124 eligible patients with unilateral MCA stenosis undergoing four-dimensional CTA were retrospectively included. Computational fluid dynamics model was reconstructed from the peak arterial phase CTA to calculate CT-FFR. MTT > 6.5 s was defined as cerebral hypoperfusion. Recurrent ischemic event within 1 year was recorded.
RESULTS: Of 124 patients, 19 had recurrent ischemic event, with lower CT-FFR value than non-recurrent ischemia group (median 0.72 vs. 0.83, p = 0.02). The cerebral hypoperfusion-specific CT-FFR cut-off value of 0.80 was independently associated with recurrent ischemic event (adjusted hazard ratio, 2.97 [95%CI: 1.32, 7.14]; p = 0.03). CT-FFR provided improved prognostic value beyond DS alone with the area under the curve value upon leave-one-out cross-validation (0.72 [95%CI: 0.64, 0.80] vs. 0.66 [95%CI: 0.57, 0.74]; p = 0.001), C-index (0.704 [95%CI: 0.613, 0.795] vs. 0.648 [95%CI: 0.573, 0.723]; p = 0.002) and categorical net reclassification improvement index (0.264 [95%CI: 0.096, 0.479]; p = 0.03).
CONCLUSION: A CT-FFR threshold specific to CTP-based hypoperfusion may achieve improved value compared to DS alone for predicting recurrent ischemic event within 1 year in patients with symptomatic MCA stenosis.
MATERIALS AND METHODS: 124 eligible patients with unilateral MCA stenosis undergoing four-dimensional CTA were retrospectively included. Computational fluid dynamics model was reconstructed from the peak arterial phase CTA to calculate CT-FFR. MTT > 6.5 s was defined as cerebral hypoperfusion. Recurrent ischemic event within 1 year was recorded.
RESULTS: Of 124 patients, 19 had recurrent ischemic event, with lower CT-FFR value than non-recurrent ischemia group (median 0.72 vs. 0.83, p = 0.02). The cerebral hypoperfusion-specific CT-FFR cut-off value of 0.80 was independently associated with recurrent ischemic event (adjusted hazard ratio, 2.97 [95%CI: 1.32, 7.14]; p = 0.03). CT-FFR provided improved prognostic value beyond DS alone with the area under the curve value upon leave-one-out cross-validation (0.72 [95%CI: 0.64, 0.80] vs. 0.66 [95%CI: 0.57, 0.74]; p = 0.001), C-index (0.704 [95%CI: 0.613, 0.795] vs. 0.648 [95%CI: 0.573, 0.723]; p = 0.002) and categorical net reclassification improvement index (0.264 [95%CI: 0.096, 0.479]; p = 0.03).
CONCLUSION: A CT-FFR threshold specific to CTP-based hypoperfusion may achieve improved value compared to DS alone for predicting recurrent ischemic event within 1 year in patients with symptomatic MCA stenosis.