PT  - JOURNAL ARTICLE
AU  - Rimal H Dossani
AU  - Muhammad Waqas
AU  - Hamid H Rai
AU  - Michael K Tso
AU  - Gary B Rajah
AU  - Aleeza Safdar
AU  - Adnan H Siddiqui
TI  - Measurement of instant flow reserve to quantify functional flow limitation across stenosis in intracranial atherosclerotic disease
AID  - 10.1136/neurintsurg-2020-016080
DP  - 2020 Dec 01
TA  - Journal of NeuroInterventional Surgery
PG  - 1248--1248
VI  - 12
IP  - 12
4099  - http://jnis.bmj.com/content/12/12/1248.short
4100  - http://jnis.bmj.com/content/12/12/1248.full
SO  - J NeuroIntervent Surg2020 Dec 01; 12
AB  - Angiographic stenosis may not be an accurate reflection of physiological flow limitation. Measurement of instant flow reserve (IFR) to quantify functional flow limitation across stenosis may be valuable in identifying lesions causing significant flow limitation. A case of left middle cerebral artery atherosclerotic disease is presented. Because medical therapy had failed, endovascular revascularization was chosen. In this video 1, IFR measurement to guide submaximal balloon angioplasty with a 1.5×9 mm non-compliant Mini-Trek balloon (Abbott) is demonstrated. Pressure gradient across the middle cerebral artery-M1 stenosis was measured with a Volcano pressure wire (Philips) before and after submaximal balloon angioplasty. An excellent radiographic result and flow improvement into the severely stenosed segment were achieved, with an IFR increase from 0.23 to 0.89. The degree of corresponding stenosis changed from 85% to 30%. No periprocedural complication was observed. IFR can help to identify lesions requiring treatment in select patients and prevent the tendency to overtreat a lesion that is not physiologically significant.