Noninvasive fractional flow in intracranial atherosclerotic stenosis: Reproducibility, limitations, and perspectives

During the past 2 decades, fractional flow reserve (FFR) obtained at percutaneous coronary angiography that denotes pressure gradient across coronary artery stenosis has been considered diagnostic of ischemia-causing lesions and useful in guiding revascularization and prognostication [ [1] Berry C. Corcoran D. Hennigan B. Watkins S. Layland J. Oldroyd K.G. Fractional flow reserve-guided management in stable coronary disease and acute myocardial infarction: recent developments. Eur. Heart J. 2015; 36: 3155-3164 Crossref PubMed Scopus (45) Google Scholar ]. FFR derived noninvasively, from computational fluid dynamics (CFD) models based on CT angiography (CTA), has been suggested of a moderate-to-high diagnostic accuracy (0.69 to 0.86) in detecting ischemia-causing coronary stenoses with reference to the invasive FFR [ [2] Xu R. Li C. Qian J. Ge J. Computed tomography-derived fractional flow reserve in the detection of lesion-specific ischemia: an integrated analysis of 3 pivotal trials. Med. (Baltimore). 2015; 94: e1963 Crossref PubMed Scopus (12) Google Scholar ].