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Peer-reviewedCC BY 4.0Frontiers in Neurology

Angiography-derived fractional flow and clinical outcomes in symptomatic intracranial atherosclerotic stenosis

  • Wanning Zheng1,2
  • Rong Zou3
  • Ming Wang1,2,4
  • Jiahao Tang1,4
  • Ruilin Chen1,4
  • Chaobo Zheng1,2
  • Jie Gong1,2
  • Yuhai Gao1,2
  • Ning Wang1,2
  • Yuning Lu1,2
  • Jiong Wu1,2
  • Jens Fiehler5
3 more authors
  • Adnan H. Siddiqui6
  • Jianping Xiang3
  • Shu Wan1,2,4
6 affiliations
  1. 1Brain Center, Zhejiang Hospital
  2. 2Zhejiang Province Engineering Research Center for Precision Medicine in Cerebrovascular Diseases
  3. 3ArteryFlow Technology Co., Ltd.
  4. 4The Second School of Clinical Medicine, Zhejiang Chinese Medical University
  5. 5Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf
  6. 6Department of Neurosurgery, University of Buffalo
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Abstract

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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Cite

BibTeXRIS
BibTeX
@article{zheng2026angiographyderived,
  title = {{Angiography-derived fractional flow and clinical outcomes in symptomatic intracranial atherosclerotic stenosis}},
  author = {Wanning Zheng and Rong Zou and Ming Wang and Jiahao Tang and Ruilin Chen and Chaobo Zheng and Jie Gong and Yuhai Gao and Ning Wang and Yuning Lu and Jiong Wu and Jens Fiehler and Adnan H. Siddiqui and Jianping Xiang and Shu Wan},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1944177},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1944177/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Angiography-derived fractional flow and clinical outcomes in symptomatic intracranial atherosclerotic stenosis
AU  - Wanning Zheng
AU  - Rong Zou
AU  - Ming Wang
AU  - Jiahao Tang
AU  - Ruilin Chen
AU  - Chaobo Zheng
AU  - Jie Gong
AU  - Yuhai Gao
AU  - Ning Wang
AU  - Yuning Lu
AU  - Jiong Wu
AU  - Jens Fiehler
AU  - Adnan H. Siddiqui
AU  - Jianping Xiang
AU  - Shu Wan
PY  - 2026
DA  - 2026/10/15
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1944177
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1944177/full
AB  - 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.
SN  - 1664-2295
ER  -