Why the study?
The association between angiography-derived fractional flow (FF) and clinical outcomes in patients with symptomatic intracranial atherosclerotic stenosis (ICAS), as well as its potential role in patient stratification, required exploration.
Does angiography-derived fractional flow (FF ≤ 0.76) stratify clinical functional outcomes (mRS and NIHSS at 12 months) between endovascular intervention and conservative medical management in patients with symptomatic intracranial atherosclerotic stenosis?
Cohort (n=132)
No
Does angiography-derived fractional flow (FF ≤ 0.76) stratify clinical functional outcomes (mRS and NIHSS at 12 months) between endovascular intervention and conservative medical management in patients with symptomatic intracranial atherosclerotic stenosis?
Answers are grounded in this paper and cite their sources.
Angiography-derived fractional flow (FF ≤ 0.76) may offer complementary physiological risk stratification beyond anatomical stenosis severity in symptomatic ICAS, though baseline imbalances and non-significant interaction tests necessitate prospective validation.
Background To explore the association between fractional flow (FF) and clinical outcomes in patients with symptomatic intracranial atherosclerotic stenosis (ICAS), and to evaluate its potential role in patient stratification. Methods This retrospective exploratory study included symptomatic ICAS patients hospitalized between March 2019 and May 2024. FF values were derived from digital subtraction angiography using an angiography-based computational method. Patients were stratified according to a pre-specified FF threshold of 0.76 and treatment modality (interventional vs. conservative). Clinical outcomes were assessed using the modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) at discharge and 12 months. Results Among patients with FF ≤ 0.76, no worsening in mRS between discharge and 12 months was observed in 96.3% of the interventional group and 78.6% of the conservative group ( p = 0.017). In a post hoc analysis, improvement of at least one mRS point occurred in 46.3 and 17.9%, respectively; however, discharge mRS scores differed between groups, and the difference in improvement was not statistically significant when the analysis was restricted to patients with discharge mRS ≥ 1. No significant differences in mRS or NIHSS improvement were observed between treatment strategies in patients with FF > 0.76 ( p > 0.05). In contrast, stratification based on degree of stenosis (DS% ≥ 70%) did not differentiate clinical outcomes between treatment groups. These findings suggest that FF-based stratification may be associated with differences in functional outcomes across treatment strategies. Conclusion FF may provide additional information for risk stratification in symptomatic ICAS patients and may help identify clinically relevant subgroups for further evaluation. However, these findings should be considered exploratory and require validation in larger prospective studies.
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Zheng et al. (2026) conducted a cohort in Symptomatic intracranial atherosclerotic stenosis (ICAS) (n=132). Endovascular interventional treatment (intracranial stenting or balloon angioplasty alone) plus dual antiplatelet and lipid-lowering therapy stratified by angiography-derived fractional flow (FF ≤ 0.76) vs. Conservative medical management alone (dual antiplatelet and lipid-lowering therapy) was evaluated on No worsening in modified Rankin Scale (mRS) score between discharge and 12 months in patients with FF ≤ 0.76 (p=0.017).
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