A Novel Pressure Waveform Analysis Approach to Identify Occlusive Events During Endovascular Treatments

Introduction: During intravascular procedures, unexpected occlusive events can result in serious complications. Real-time blood pressure waveform monitoring provides valuable insights into intravascular hemodynamics, potentially enabling the early detection of these critical changes. This study aimed to determine whether variations in pressure waveforms correlate with occlusive events.

Methods: We retrospectively reviewed consecutive patients who underwent endovascular treatment with continuous intravascular pressure monitoring via an indwelling catheter. For each heartbeat, we performed a frequency analysis of the blood pressure waveform to assess whether changes in power across different frequency ranges could distinguish between normal and occlusive states. A receiver operating characteristic (ROC) analysis was subsequently conducted to evaluate the predictive power of the identified frequency bands.

Results: A total of 32 patients were included, of whom 11 experienced occlusive events (2 parent artery occlusions for intracranial aneurysms, 6 balloon-assisted coiling procedures for intracranial aneurysms, 1 balloon test occlusion, and 2 thrombotic embolisms). Ten patients were male, and the median age was 62.5 years (range: 40–81). In all 11 occlusive events, the power of the blood pressure wave in the 6–10 Hz range was significantly higher during the occlusive state than in the non-occlusive state (p < 0.001). ROC analysis showed that a 13% increase in this frequency band’s power yielded a sensitivity of 92%, a specificity of 85%, and an area under the curve of 0.942.

Conclusion : These findings suggest that intravascular pressure waveforms undergo significant alterations during occlusive events. By capturing these real-time waveform changes, clinicians may facilitate prompt detection of occlusive states and enable more informed decision-making in endovascular treatments.