Abstract Details

Title Correlation between Degree of Stenosis and Intravascular Flow in Intracranial Stenosis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 223

Objective

Background BACKGROUND: Degree of arterial stenosis by digital subtraction angiography (DSA) remains the gold standard for measurement of severity in intracranial atherosclerotic disease (ICAD). Intravascular flow measurements using quantitative magnetic resonance angiography (QMRA) provide a tool to assess the hemodynamic consequence of stenotic lesions. We sought to compare degree of stenosis by DSA measurement to intravascular volumetric flow by QMRA measurement.

Design/Methods DESIGN/METHODS: In a single center, retrospective review, we abstracted data from patients with: 1) DSA and QMRA completed within 1 month of each other; 2) no intervention performed during DSA; 3) measureable degree of stenosis in a middle cerebral artery (MCA) stem from 1-99% per WASID criteria on DSA; and 4) measureable volumetric flow rate (VFR) in the post-stenotic segment of the MCA by QMRA. We performed paired analyses of DSA and QMRA measurements in the MCA using scatter plots and correlational statistics.

Results RESULTS: Among 13 patients, there were 17 stenotic MCA lesions with paired DSA and QMRA measurements. The median degree of stenosis was 48% and median VFR was 66 mL/min. There was strong inverse correlation between degree of stenosis and VFR (rs=-0.762). However, agreement between QMRA and DSA declined with increasing severity of stenosis. Of the 6 lesions with severe (70-99%) stenosis, only 2 were associated with low flow (< 50 mL/min). Among 2 moderate (50-69%) stenoses, 1 had low flow and 1 had borderline low flow (50-70 mL/min). Among the mild (< 50%) stenoses, 8 of 9 had normal flow (> 70 mL/min) while 1 had borderline low flow.

Conclusions CONCLUSIONS: There is incomplete agreement between moderate and severe stenosis measurement by DSA and intravascular flow measurement by QMRA. QMRA may help identify the subset with hemodynamic compromise distal to moderate or severe intracranial stenosis.

Authors/Disclosures
Lakshmi Warrior, MD, FAAN PRESENTER	Dr. Warrior has nothing to disclose.
	No disclosure on file
Jose G. Romano, MD, FAAN (University of Miami, Miller School of Medicine)	Dr. Romano has stock in Vycor Medical/NovaVision. The institution of Dr. Romano has received research support from NIH/NINDS. The institution of Dr. Romano has received research support from NIH/NHLBI.
Suhayl S. Dhib-Jalbut, MD, FAAN (Rutgers University)	No disclosure on file
David S. Liebeskind, MD, FAAN (Neurovascular Imaging Research Core at UCLA)	Dr. Liebeskind has received research support from Cerenovus. Dr. Liebeskind has received research support from Genentech . Dr. Liebeskind has received research support from Medtronic. Dr. Liebeskind has received research support from Stryker.
Shyam Prabhakaran, MD (University of Chicago)	Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. The institution of Dr. Prabhakaran has received research support from NIH . The institution of Dr. Prabhakaran has received research support from AHRQ. Dr. Prabhakaran has received publishing royalties from a publication relating to health care.

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