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- Title
Puncturing Plaques.
- Authors
Roy, Trisha; Liu, Garry; Shaikh, Noor; Dueck, Andrew D.; Wright, Graham A.
- Abstract
<bold>Purpose: </bold>To test and validate magnetic resonance imaging (MRI) sequences for peripheral artery lesion characterization and relate the MRI characteristics to the amount of force required for a guidewire to puncture peripheral chronic total occlusions (CTOs) as a surrogate for immediate failure of endovascular therapy.<bold>Methods: </bold>Diseased superficial femoral, popliteal, and tibial artery segments containing 55 atherosclerotic lesions were excised from the amputated limbs of 7 patients with critical limb ischemia. The lesions were imaged at high resolution (75 μm3 voxels) with T2-weighted (T2W) and ultrashort echo time (UTE) sequences on a 7-T MR scanner. The MR images (n=15) were validated with micro-computed tomography and histology. CTOs (n=40) were classified by their MR signal characteristics as "soft" (signals indicating fat, thrombus, microchannels, or loose fibrous tissue), "hard" (collagen and/or speckled calcium signals), or "calcified" (calcified nodule signals). A 2-kg load cell advanced the back end of a 0.035-inch stiff guidewire at a fixed displacement rate (0.05 mm/s) through the CTOs, and the forces required to cross each lesion were measured.<bold>Results: </bold>T2W images showed fat as hyperintense and hardened tissue as hypointense. Calcium and thrombus appeared as a signal void in conventional MRI sequences but were easily identified in UTE images (thrombus was hyperintense and calcium hypointense). MRI accurately differentiated "hard," "soft," and "calcified" CTOs based on associated guidewire puncture force. The guidewire could not enter "calcified" CTOs (n=6) at all. "Hard" CTOs (n=9) required a significantly higher (p<0.001) puncture force of 1.71±0.51 N vs 0.43±0.36 N for "soft" CTOs (n=25).<bold>Conclusion: </bold>MRI characteristics of PAD lesions correlate with guidewire puncture forces, an important aspect of crossability. Future work will determine if clinical MR scanners can be used to predict success in peripheral vascular interventions.
- Subjects
PERIPHERAL vascular disease treatment; ATHEROSCLEROSIS; COMPARATIVE studies; FEMORAL artery; MAGNETIC resonance imaging; RESEARCH methodology; MEDICAL cooperation; PERIPHERAL vascular diseases; RESEARCH; RESEARCH evaluation; OPERATIVE surgery; EVALUATION research; PREDICTIVE tests; PATIENT selection; TIBIAL arteries; POPLITEAL artery; CALCINOSIS; THERAPEUTICS
- Publication
Journal of Endovascular Therapy, 2017, Vol 24, Issue 1, p35
- ISSN
1526-6028
- Publication type
journal article
- DOI
10.1177/1526602816671135