Objectives To evaluate the diagnostic performance of Angio-based fractional flow (Angio-FF) compared to the degree of stenosis (DS) in identifying symptomatic intracranial vertebrobasilar artery stenosis (IVBS) and assess its utility across lesion subgroups. Materials and methods A retrospective analysis of patients with IVBS was conducted at our institution. Inclusion criteria included patients aged > 18 years with unilateral IVBS (40–90%) confirmed by digital subtraction angiography. Angio-FF was calculated using specialized software. Diagnostic accuracy, sensitivity, specificity, positive/negative predictive values (PPV/NPV), and the area under the curve (AUC) were compared between Angio-FF and DS. Results In 120 patients, 84 were symptomatic, and 36 were asymptomatic. The median Angio-FF value was significantly lower in symptomatic lesions (0.66 vs. 0.88, p < 0.001). Angio-FF showed superior diagnostic performance over DS in identifying symptomatic IVBS (AUC: 0.847 vs. 0.640; p < 0.001). The optimal Angio-FF cutoff value for distinguishing symptomatic IVBS was 0.74, with sensitivity, specificity, and accuracy of 71.4%, 86.1%, and 75.8%, respectively. Additionally, Angio-FF showed relatively good diagnostic performance across various lesion subgroups, including different lesion lengths, location, and DS. Conclusions Angio-FF outperformed DS in identifying symptomatic IVBS. It may serve as a reliable tool for identifying symptomatic IVBS in diverse patient populations. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Does Angio-based fractional flow (Angio-FF) provide superior diagnostic accuracy compared to the degree of stenosis alone in identifying symptomatic intracranial vertebrobasilar artery stenosis (IVBS)? <Emphasis Type="BoldItalic">Findings</Emphasis> Angio-FF demonstrated superior diagnostic accuracy, with an optimal cutoff value of 0.74 and consistent performance across various lesion subgroups. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Angio-FF improves hemodynamic risk stratification in IVBS and may facilitate more individualized treatment strategies. Graphical Abstract

Angiography versus angio-based fractional flow in assessing intracranial vertebrobasilar artery stenosis

期刊论文
发表日期：

2025年12月4日

查看全文

Yongsheng Liu,
Guiwen Shao,
Yuxiang Liu,
Yongjian Liu,
Feng Wang

摘要

Objectives

To evaluate the diagnostic performance of Angio-based fractional flow (Angio-FF) compared to the degree of stenosis (DS) in identifying symptomatic intracranial vertebrobasilar artery stenosis (IVBS) and assess its utility across lesion subgroups.

Materials and methods

A retrospective analysis of patients with IVBS was conducted at our institution. Inclusion criteria included patients aged > 18 years with unilateral IVBS (40–90%) confirmed by digital subtraction angiography. Angio-FF was calculated using specialized software. Diagnostic accuracy, sensitivity, specificity, positive/negative predictive values (PPV/NPV), and the area under the curve (AUC) were compared between Angio-FF and DS.

Results

In 120 patients, 84 were symptomatic, and 36 were asymptomatic. The median Angio-FF value was significantly lower in symptomatic lesions (0.66 vs. 0.88, p < 0.001). Angio-FF showed superior diagnostic performance over DS in identifying symptomatic IVBS (AUC: 0.847 vs. 0.640; p < 0.001). The optimal Angio-FF cutoff value for distinguishing symptomatic IVBS was 0.74, with sensitivity, specificity, and accuracy of 71.4%, 86.1%, and 75.8%, respectively. Additionally, Angio-FF showed relatively good diagnostic performance across various lesion subgroups, including different lesion lengths, location, and DS.

Conclusions

Angio-FF outperformed DS in identifying symptomatic IVBS. It may serve as a reliable tool for identifying symptomatic IVBS in diverse patient populations.

Key Points

Question Does Angio-based fractional flow (Angio-FF) provide superior diagnostic accuracy compared to the degree of stenosis alone in identifying symptomatic intracranial vertebrobasilar artery stenosis (IVBS)?

Findings Angio-FF demonstrated superior diagnostic accuracy, with an optimal cutoff value of 0.74 and consistent performance across various lesion subgroups.

Clinical relevance Angio-FF improves hemodynamic risk stratification in IVBS and may facilitate more individualized treatment strategies.

Graphical Abstract