Background: Cerebrovascular events are frequently associated with hemodynamic\ndisturbance caused by internal carotid artery (ICA) stenosis. It is challenging to determine\nthe ischemia-related carotid stenosis during the intervention only using digital\nsubtracted angiography (DSA). Inspired by the performance of well-established FFRct\ntechnique in hemodynamic assessment of significant coronary stenosis, we introduced\na pressure-based carotid arterial functional assessment (CAFA) index generated from\ncomputational fluid dynamic (CFD) simulation in DSA data, and investigated its feasibility\nin the assessment of hemodynamic disturbance preliminarily using pressure-wired\nmeasurement and arterial spin labeling (ASL) MRI as references.\nMethods: The cerebral multi-delay multi-parametric ASL-MRI and carotid DSA including\ntrans-stenotic pressure-wired measurement were implemented on a 65-year-old\nman with asymptomatic unilateral (left) ICA stenosis. A CFD simulation using simplified\nboundary condition was performed in DSA data to calculate the CAFA index. The\ncerebral blood flow (CBF) and arterial transit time (ATT) of ICA territories were acquired.\nResults: CFD simulation showed good correlation (r = 0.839, P = 0.001) with slight systematic\noverestimation (mean difference âË?â?? 0.007, standard deviation 0.017) compared\nwith pressure-wired measurement. No significant difference was observed between\nthem (P = 0.09). Though the narrowing degree of in the involved ICA was about 70%,\nthe simulated and measured CAFA (0.942/0.937) revealed a functionally nonsignificant\nstenosis which was also verified by a compensatory final CBF (fronto-temporal/frontoparietal\nregion: 51.58/45.62 ml/100 g/min) and slightly prolonged ATT (1.23/1.4 s)\nin the involved territories, together with a normal leftââ?¬â??right percentage difference\n(2.1ââ?¬â??8.85%).\nConclusions: The DSA based CFD simulation showed good consistence with invasive\napproach and could be used as a cost-saving and efficient way to study the\nrelationship between hemodynamic disorder caused by ICA stenosis and subsequent\nperfusion variations in brain. Further research should focus on the role of noninvasive\npressure-based CAFA in screening asymptomatic ischemia-causing carotid stenosis.
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