Key result
Pressure wire RFR increases after carotid stenting and correlates with ultrasound and angiographic stenosis.
Why the study?
Non-invasive techniques have limitations in grading carotid stenosis, and the hemodynamic impact and correlation between pressure wire-derived resting full-cycle ratio and morphological or hemodynamic parameters remain undefined.
Does resting full-cycle ratio (RFR) measured by pressure wire correlate with ultrasound velocities and stenosis degree in patients with symptomatic carotid artery stenosis?
Observational (n=15)
Does resting full-cycle ratio (RFR) measured by pressure wire correlate with ultrasound velocities and stenosis degree in patients with symptomatic carotid artery stenosis?
Resting full-cycle ratio measured by pressure wire correlates significantly with carotid ultrasound values and stenosis degree, suggesting its potential utility as a hemodynamic index during carotid artery stenting.
RFR may index carotid stenosis hemodynamics; leaves open its role in stenting pending prospective validation.
INTRODUCTION: Grading of carotid stenosis is routinely performed with non-invasive techniques, such as carotid ultrasound (CUS) and computerized tomography angiography (CTA), which have limitations in grading definition. Moreover, the actual hemodynamic impact of a stenosis remains poorly defined. Preliminary studies explored the application of the resting full-cycle ratio (RFR), measured with pressure wire (PW), but the correlation between RFR and morphological/hemodynamic parameters is still undefined. This study aims to test the correlation between RFR and CUS-CTA-DSA based degree of stenosis, to define the suitability of RFR as carotid stenosis index. METHODS: We included patients with symptomatic carotid stenosis receiving carotid artery stenting (CAS), between November 2022 and May 2023. We performed CUS and PW measurements before and after stenting, at four different sites (trans-lesion, distal cervical, petrous and supraclinoid internal carotid artery [ICA] segments). We compared CUS and PW parameters by Pearson's or Spearman test for continuous variables. RESULTS: Among 15 patients included the mean stenosis degree was 81.3%. Trans-lesion RFR was significantly higher than other sites (0.72 ± 0.2 trans-lesion vs. 0.69 ± 0.18 distal cervical ICA vs. 0.66 ± 0.2 petrous ICA vs. 0.6 ± 0.2 intracranial ICA, p < 0.05). All RFR values significantly increased after treatment; the highest relative increase was registered at stenosis site (0.72 ± 0.2 pre-stent vs. 1.01 ± 0.1 post-stent, p < 0.01). Trans-lesion RFR was significantly associated with the CTA and DSA stenosis degree and CUS measurements. CONCLUSIONS: Pressure wire in carotid artery stenosis seems safe and suitable. Resting full-cycle ratio has a significant correlation with CUS values and stenosis degree and might be used as carotid stenosis index during CAS.
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Diana et al. (2023) conducted an observational in symptomatic carotid stenosis (n=15). Resting full-cycle ratio (RFR) measurement via pressure wire was evaluated on Correlation between RFR and CUS-CTA-DSA based degree of stenosis. Resting full-cycle ratio measured by pressure wire significantly increased after carotid stenting (0.72 vs 1.01, p<0.01) and correlated with ultrasound and angiographic stenosis measurements.
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