Cohort study reveals higher lesion-level flow helicity predicts 1-year target-vessel stroke in symptomatic intracranial stenosis, suggesting its utility as a hemodynamic risk marker.
Key Points
To determine whether computational fluid dynamics-derived flow helicity within culprit intracranial atherosclerotic lesions is associated with 1-year target-vessel stroke.
Analyzed 204 adults with symptomatic intracranial atherosclerotic stenosis who had CT angiography-based vascular reconstruction and computational fluid dynamics modeling.
Measured maximum absolute flow helicity at the narrowest cross-sectional plane of the culprit stenosis (standardized per SD on a log-transformed scale).
Evaluated 1-year target-vessel stroke using multivariable Cox models adjusted for major clinical, anatomical, and hemodynamic covariates alongside tertile and Kaplan-Meier analyses.
Among 203 patients in multivariable analysis, 31 target-vessel strokes occurred; each 1 SD increase in log helicity was associated with target-vessel stroke (HR 1.461, 95% CI 1.049 to 2.035, P=0.0249).
Patients in the highest helicity tertile had a significantly higher risk of target-vessel stroke than those in the lowest tertile (HR 2.951, 95% CI 1.067 to 8.160, P=0.0371).
Association with the secondary composite endpoint of target-territory stroke or vascular death (33 events) was not statistically significant (HR 1.351, 95% CI 0.973 to 1.875, P=0.0720).