{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:28:01Z","timestamp":1792088881278,"version":"4.4.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Rationale and objectives<\/jats:title>\n                    <jats:p>CT-derived fractional flow reserve (CT-FFR) has rarely been used to evaluate the hemodynamic changes of cerebral arterial stenosis. We aimed to investigate the role of CT-FFR in predicting recurrent ischemic risk in patients with symptomatic middle cerebral artery (MCA) stenosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>124 eligible patients with unilateral MCA stenosis undergoing four-dimensional CTA were retrospectively included. Computational fluid dynamics model was reconstructed from the peak arterial phase CTA to calculate CT-FFR. MTT\u202f&amp;gt;\u202f6.5\u202fs was defined as cerebral hypoperfusion. Recurrent ischemic event within 1\u202fyear was recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 124 patients, 19 had recurrent ischemic event, with lower CT-FFR value than non-recurrent ischemia group (median 0.72 vs. 0.83,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.02). The cerebral hypoperfusion-specific CT-FFR cut-off value of 0.80 was independently associated with recurrent ischemic event (adjusted hazard ratio, 2.97 [95%CI: 1.32, 7.14];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.03). CT-FFR provided improved prognostic value beyond DS alone with the area under the curve value upon leave-one-out cross-validation (0.72 [95%CI: 0.64, 0.80] vs. 0.66 [95%CI: 0.57, 0.74];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001), C-index (0.704 [95%CI: 0.613, 0.795] vs. 0.648 [95%CI: 0.573, 0.723];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.002) and categorical net reclassification improvement index (0.264 [95%CI: 0.096, 0.479];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.03).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A CT-FFR threshold specific to CTP-based hypoperfusion may achieve improved value compared to DS alone for predicting recurrent ischemic event within 1\u202fyear in patients with symptomatic MCA stenosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1838968","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T04:51:40Z","timestamp":1781671900000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["CT - derived fractional flow reserve can predict recurrent ischemia in patients with MCA stenosis"],"prefix":"10.3389","volume":"17","author":[{"given":"Zhuhao","family":"Yin","sequence":"first","affiliation":[{"name":"Department of Radiology, Jinling Hospital, Nanjing Medical University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tongyuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Jinling Hospital, Nanjing Medical University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changsheng","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Guo","sequence":"additional","affiliation":[{"name":"Shanghai United Imaging Medical Technology Group Co., Ltd.","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Wei","sequence":"additional","affiliation":[{"name":"Shanghai United Imaging Medical Technology Group Co., Ltd.","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifei","family":"Ma","sequence":"additional","affiliation":[{"name":"Shanghai United Imaging Medical Technology Group Co., Ltd.","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wusheng","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqing","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long Jiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1161\/STROKEAHA.113.003508","article-title":"Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese intracranial atherosclerosis (CICAS) study","volume":"45","author":"Wang","year":"2014","journal-title":"Stroke"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1016\/S1474-4422(21)00376-8","article-title":"Intracranial atherosclerotic stenosis: risk factors, diagnosis, and treatment","volume":"14","author":"Gutierrez","year":"2015","journal-title":"Lancet Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1212\/WNL.0000000000001972","article-title":"Dual antiplatelet therapy in stroke and ICAS: subgroup analysis of CHANCE","volume":"85","author":"Liu","year":"2015","journal-title":"Neurology"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1177\/1747493016685716","article-title":"Intracranial atherosclerosis: from anatomy to pathophysiology","volume":"12","author":"Pu","year":"2017","journal-title":"Int J Stroke"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1056\/NEJMoa1105335","article-title":"Stenting versus aggressive medical therapy for intracranial arterial stenosis","volume":"365","author":"Chimowitz","year":"2011","journal-title":"N Engl J Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.1001\/jama.2015.1693","article-title":"Effect of a balloon-expandable intracranial stent vs medical therapy on risk of stroke in patients with symptomatic intracranial stenosis: the VISSIT randomized clinical 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