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Original research
Correlation between intracranial vertebral artery stenosis diameter measured by digital subtraction angiography and cross-sectional area measured by optical coherence tomography
  1. Yao Feng1,2,
  2. Tingxia Wu3,
  3. Tao Wang1,2,
  4. Yingying Li3,
  5. Mengyue Li3,
  6. Long Li1,2,
  7. Bin Yang1,2,
  8. Xuesong Bai1,2,
  9. Xiao Zhang1,2,
  10. Yabing Wang1,2,
  11. Peng Gao1,2,3,
  12. Yanfei Chen1,2,
  13. Yan Ma1,2,
  14. Liqun Jiao1,2,3
  1. 1 Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
  2. 2 China International Neuroscience Institute (China-INI), Beijing, China
  3. 3 Department of Interventional Neuroradiology, Xuanwu Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr Liqun Jiao, Department of Neurosurgery, Xuanwu Hospital, Beijing 100053, China; liqunjiao{at}


Background Intracranial vertebral artery (V4 segment) stenosis quantification traditionally uses the narrowest stenosis diameter. However, the stenotic V4 lumen is commonly irregularly shaped. Optical coherence tomography (OCT) allows a more precise calculation of V4 geometry. We compared the narrowest diameter stenosis (DS), measured by digital subtraction angiography (DSA), with the area stenosis (AS), measured by OCT. We hypothesized that DS is the gold standard for measuring the degree of stenosis.

Methods Five neuroradiologists evaluated 49 stenosed V4 segments in a blinded protocol. V4 stenosis was measured in millimeters on DSA at its narrowest diameter. OCT was used to estimate the cross-sectional luminal area. We also used automated software to measure DS. Three different angles (anterior, lateral, and oblique views) were used for calculations, and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and Warfarin–Aspirin Symptomatic Intracranial Disease (WASID) methods were used in all measurements. Spearman’s R values were calculated. Non-linear regression analysis was performed between the DS and AS, with statistically different correlations.

Results A high correlation was observed between the WASID and NASCET methods to measure DS with observer measurement and automated software. A good correlation was found between DS measured by observers and AS measured by OCT. Non-linear regression analysis showed that only observer measurement using the oblique view and the WASID method could attain statistically significant differences, but it was weak (r=0.389).

Conclusion Measurement of the narrowest diameter was not a reliable predictor of the cross-sectional area of V4 stenosis. Larger studies are therefore needed to develop a new evaluation system based on V4 stenosis.

  • stroke
  • stenosis
  • artery
  • atherosclerosis

Data availability statement

Data are available upon reasonable request. The data used to support the findings of this study are available from the corresponding author upon request.

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Data availability statement

Data are available upon reasonable request. The data used to support the findings of this study are available from the corresponding author upon request.

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  • YF and TW are joint first authors.

  • YF and TW contributed equally.

  • Contributors LJ, YF, TiW: study design, acquired and analyzed the data, statistical analysis, and manuscript drafting. BY, YW, PG, YC, YM: acquired and analyzed the data. YF, TiW, YL, ML, LL: data collection. TaW, XB, XZ: revised the draft paper. LJ: study design and revision of manuscript.

  • Funding This work was supported by the National Key Research and Development Project grant number 2016YFC1301703.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.