Abstract Background and aims Three-dimensional, modifiable simulations of cerebral blood flow provide promising approaches for individualized diagnostics, monitoring and therapy in patients with ischemic stroke (IS). The aim of this study is to validate a novel simulation technique in patients with relevant large artery atherosclerosis (LAA). Methods Consecutive patients with IS and hemodynamically relevant LAA identified in CT-angiography were included. 3D-models were created based on a standard CTA with a slice thickness of 0.75 mm. Neurovascular ultrasound (nvUS)-derived flow velocities of the intracranial arteries were compared and simulations performed prior and after adjustments of the systemic blood pressure (SBP) in cases of hypoperfusion. Results Forty-four patients with IS were included, with 31 showing extra-, 7 intra-, and 6 patients both combined stenosis. Significant correlations were observed between simulated and nvUS-derived velocities (p0.001); overall mean differences of flow velocities between both modalities was 10 cm/s. In 50% of cases with hemodynamically relevant ICA-stenosis, hypoperfusion of the ipsilateral ACA/MCA was noted (see Fig. 1). Repeated simulations with modification of the SBP in the ACC/VA indicated that an average increase of 32.7 mmHg would have been necessary to compensate for the hypoperfusion (see Fig. 2). Conclusions Significant correlations were found between simulated and nvUS-based flow velocities in IS patients with LAA, with a high detection rate of hypoperfused vessels. The simulation technique could be used to derive target SBPs to overcome these hypoperfusions. Whether this approach leads to improved outcomes in the acute treatment phase of IS needs to be evaluated in a prospective study. Conflict of interest All authors have nothing to disclose Figure 1 - belongs to Results Figure 2 - belongs to Results
Leyhe et al. (Fri,) studied this question.