Abstract
BackgroundCerebrovascular events are frequently associated with hemodynamic disturbance caused by internal carotid artery (ICA) stenosis. It is challenging to determine the ischemia-related carotid stenosis during the intervention only using digital subtracted angiography (DSA). Inspired by the performance of well-established FFRct technique in hemodynamic assessment of significant coronary stenosis, we introduced a pressure-based carotid arterial functional assessment (CAFA) index generated from computational fluid dynamic (CFD) simulation in DSA data, and investigated its feasibility in the assessment of hemodynamic disturbance preliminarily using pressure-wired measurement and arterial spin labeling (ASL) MRI as references.MethodsThe cerebral multi-delay multi-parametric ASL-MRI and carotid DSA including trans-stenotic pressure-wired measurement were implemented on a 65-year-old man with asymptomatic unilateral (left) ICA stenosis. A CFD simulation using simplified boundary condition was performed in DSA data to calculate the CAFA index. The cerebral blood flow (CBF) and arterial transit time (ATT) of ICA territories were acquired.ResultsCFD simulation showed good correlation (r = 0.839, P = 0.001) with slight systematic overestimation (mean difference − 0.007, standard deviation 0.017) compared with pressure-wired measurement. No significant difference was observed between them (P = 0.09). Though the narrowing degree of in the involved ICA was about 70%, the simulated and measured CAFA (0.942/0.937) revealed a functionally nonsignificant stenosis which was also verified by a compensatory final CBF (fronto-temporal/fronto-parietal region: 51.58/45.62 ml/100 g/min) and slightly prolonged ATT (1.23/1.4 s) in the involved territories, together with a normal left–right percentage difference (2.1–8.85%).ConclusionsThe DSA based CFD simulation showed good consistence with invasive approach and could be used as a cost-saving and efficient way to study the relationship between hemodynamic disorder caused by ICA stenosis and subsequent perfusion variations in brain. Further research should focus on the role of noninvasive pressure-based CAFA in screening asymptomatic ischemia-causing carotid stenosis.
Highlights
Cerebrovascular events are frequently associated with hemodynamic disturbance caused by internal carotid artery (ICA) stenosis
In this study, based on a case with asymptomatic unilateral internal carotid stenosis, we introduced a pressure-based carotid arterial functional assessment (CAFA) index generated from computational fluid dynamic (CFD) simulation in digital subtracted angiography (DSA) data, and further investigated its feasibility in the assessment of hemodynamic disturbance preliminarily using invasive pressure-wired measurement and multi-delay multi-parametric arterial spin labeling (ASL)-MRI as references
With the increasing of post-labeling delay (PLD), cerebral blood flow (CBF) increased in the involved territories and the final CBF was close to the right hemisphere in spite of a slightly prolonged arterial transit time (ATT) in left
Summary
Cerebrovascular events are frequently associated with hemodynamic disturbance caused by internal carotid artery (ICA) stenosis. Angiography is the clinical standard to evaluate the severity of carotid stenosis, including Doppler ultrasonography, computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA) [6,7,8]. These routine methods can only detect the anatomical carotid stenosis. The alteration of hemodynamic function plays an important role in assessing the risk of stroke to patients with asymptomatic internal carotid stenosis [9, 10]
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