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Trans-stenotic pressure gradient measurement feasible for stenosis severity assessment
Results of a feasibility study indicate that measures of trans-stenotic pressure gradients can be safely and effectively obtained in intracranial large arteries through the use of a guidewire.
Use of a pressure gradient cutoff to identify patients who warrant stent implantation resulted in no device- or procedure-related adverse events or recurrent ischemic events among stent recipients, researchers wrote.
The study included 12 patients (mean age, 58 years) with intracranial large artery stenosis. All patients had experienced a transient ischemic attack or nondisabling stroke within 30 days of enrollment (March 2013 to May 2014).
Trans-stenotic pressure gradient was measured via PressureWire (St. Jude Medical) before or after percutaneous transluminal angioplasty and stenting, and it compared with percent diameter stenosis as a method of identifying stenotic severity. Patients with a pressure gradient 0.7 or lower underwent stent implantation, and those with a gradient of 0.8 of higher received medical management alone. For values between 0.7 and 0.8, stenting was performed at the discretion of the attending neurointerventionists.
Other evaluated factors included complications related to the device or procedure, as well as recurring cerebral ischemic events. Follow-up was performed at 24 hours after pressure measurement, hospital discharge and 30, 90 and 180 days after treatment.
Eight patients had pressure gradient values 0.7, and seven received stents after one refused implantation. All seven procedures were successful. The researchers observed a reduction in pressure gradient from 59 ± 17.2 mm Hg before treatment to 13.3 ± 13.6 mm Hg among those who underwent percutaneous transluminal angioplasty and stenting (P < .01).
All target vessels were reached and no complications related to the procedure occurred. The patient who refused stenting experienced TIA. No other evaluated events occurred, including death, embolization, intracranial hemorrhage, intramural arterial dissection or vessel perforation.
The researchers wrote that their findings “[confirm] that the pressure wire technique can acquire hemodynamic parameters of intracranial large arteries safely and effectively. ... The easy performance and high success rate of this pressure wire may facilitate the evaluation of the functional significance in cerebral arterial stenoses and improve the assessment of immediate percutaneous transluminal angioplasty and stenting results.” – by Adam Taliercio
Disclosure: The researchers report no relevant financial disclosures.