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Effect of Percutaneous Transluminal Angioplasty on Severely Stenotic Femoral Lesions

2002; Lippincott Williams & Wilkins; Volume: 106; Issue: 12 Linguagem: Inglês

10.1161/01.cir.0000033307.84687.fb

1524-4539

Roberto Corti, Rolf Wyttenbach, Mario Alerci, Juan J. Badimón, Valentı́n Fuster, Augusto Gallino,

Vascular Procedures and Complications

HomeCirculationVol. 106, No. 12Effect of Percutaneous Transluminal Angioplasty on Severely Stenotic Femoral Lesions Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBEffect of Percutaneous Transluminal Angioplasty on Severely Stenotic Femoral LesionsIn Vivo Demonstration by Noninvasive Magnetic Resonance Imaging Roberto Corti, Rolf Wyttenbach, Mario Alerci, Juan J Badimon, Valentin Fuster and Augusto Gallino Roberto CortiRoberto Corti Cardiovascular Institute, Mount Sinai School of Medicine (R.C., J.J.B., V.F.), New York, NY, and Ospedale San Giovanni, Bellinzona (R.W., M.A., A.G.), Switzerland. , Rolf WyttenbachRolf Wyttenbach Cardiovascular Institute, Mount Sinai School of Medicine (R.C., J.J.B., V.F.), New York, NY, and Ospedale San Giovanni, Bellinzona (R.W., M.A., A.G.), Switzerland. , Mario AlerciMario Alerci , Juan J BadimonJuan J Badimon , Valentin FusterValentin Fuster and Augusto GallinoAugusto Gallino Originally published17 Sep 2002https://doi.org/10.1161/01.CIR.0000033307.84687.FBCirculation. 2002;106:1570–1571The angiogram of a 68-year-old woman with severe claudication (Rutherford clinical class 3) of the right leg revealed a chronic high-grade preocclusive stenosis of the distal superficial femoral artery, with multiple collateral vessels (Figure 1A). Post-percutaneous transluminal angioplasty (PTA) angiography demonstrated restoration of both lumen and antegrade flow (Figure 1B). Cross-sectional magnetic resonance (MR) imaging performed 24 hours after PTA at the level of the arterial occlusion (Figure 2) revealed severe disruption and splitting of the atherosclerotic plaque, resulting in an irregularly shaped lumen. Angiographic and MR images were clearly discrepant, with angiography underestimating the residual lesion. The arrow in Figure 2F mimics the angio- graphic projection and explains why the angiography overestimated the result of the PTA. Download figureDownload PowerPointFigure 1. Angiography pre- and post-PTA of the right leg. PTA was performed in the distal superficial femoral artery (SFA) at the level of Hunter's channel.Download figureDownload PowerPointFigure 2. Axial, proton-density weighted high-resolution MR images of the right leg at the level of the superficial femoral artery, showing chronic high-grade preocclusive stenosis (or partially recanalized chronic occlusion) pre-PTA (A, detail C) and post-PTA (B, detail D. The residual lumen is highlighted in red in the details pictures (C and D). The arrows mimic the projection normally used in x-ray diagnostic.This case provides in vivo evidence of extensive plaque disruption induced by balloon angioplasty, and may explain mechanisms of complications of this technique. Once such mechanisms such as thrombus formation are identified, targeted therapies can be more effectively chosen. In addition, it highlights the potential overestimation of PTA results by X-ray angiography as it underestimates the residual plaque size. Therefore, cross-sectional analysis by MR imaging could be useful in follow-up to define plaque remodeling and, perhaps, to identify prognostic factors for restenosis (eg, plaque splitting).*Drs Corti and Wyttenbach contributed equally to this article.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke's Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.FootnotesCorrespondence to Prof Augusto Gallino, MD, Division of Cardiovascular Medicine, Ospedale San Giovanni, 6500 Bellinzona, Switzerland. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Cuadrado I, Saura M, Castejón B, Martin A, Herruzo I, Balatsos N, Zamorano J and Zaragoza C (2016) Preclinical models of atherosclerosis. The future of Hybrid PET/MR technology for the early detection of vulnerable plaque, Expert Reviews in Molecular Medicine, 10.1017/erm.2016.5, 18, . Gallino A, Aboyans V, Diehm C, Cosentino F, Stricker H, Falk E, Schouten O, Lekakis J, Amann-Vesti B, Siclari F, Poredos P, Novo S, Brodmann M, Schulte K, Vlachopoulos C, De Caterina R, Libby P and Baumgartner I (2014) Non-coronary atherosclerosis, European Heart Journal, 10.1093/eurheartj/ehu071, 35:17, (1112-1119), Online publication date: 1-May-2014. Corti R and Fuster V (2011) Imaging of atherosclerosis: magnetic resonance imaging, European Heart Journal, 10.1093/eurheartj/ehr068, 32:14, (1709-1719), Online publication date: 2-Jul-2011. Brown R, Karmonik C, Brunner G, Lumsden A, Ballantyne C, Johnson S, Wang Y and Morrisett J (2011) Simultaneous bilateral magnetic resonance imaging of the femoral arteries in peripheral arterial disease patients, Journal of Magnetic Resonance Imaging, 10.1002/jmri.22591, 34:1, (150-156), Online publication date: 1-Jul-2011. Corti R (2006) Noninvasive imaging of atherosclerotic vessels by MRI for clinical assessment of the effectiveness of therapy, Pharmacology & Therapeutics, 10.1016/j.pharmthera.2005.09.004, 110:1, (57-70), Online publication date: 1-Apr-2006. Gallino A, Do D, Alerci M, Baumgartner I, Cozzi L, Segatto J, Bernier J, Tutta P, Kellner F, Triller J, Schneider E, Amann-Vesti B, Studer G, Jäger K, Aschwanden M, Canevascini R, Jacob A, Kann R, Greiner R and Mahler F (2004) Effects of Probucol Versus Aspirin and Versus Brachytherapy on Restenosis After Femoropopliteal Angioplasty: The PAB Randomized Multicenter Trial , Journal of Endovascular Therapy, 10.1583/04-1269MR.1, 11:6, (595-604), Online publication date: 1-Dec-2004. Wyttenbach R, Gallino A, Alerci M, Mahler F, Cozzi L, Di Valentino M, Badimon J, Fuster V and Corti R (2004) Effects of Percutaneous Transluminal Angioplasty and Endovascular Brachytherapy on Vascular Remodeling of Human Femoropopliteal Artery by Noninvasive Magnetic Resonance Imaging, Circulation, 110:9, (1156-1161), Online publication date: 31-Aug-2004. Nielles-Vallespin S (2012) Short T 2 / T 2 * Imaging of Calcification in Atherosclerosis eMagRes, 10.1002/9780470034590.emrstm1251, Online publication date: 6-Mar-1996. September 17, 2002Vol 106, Issue 12 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000033307.84687.FBPMID: 12234966 Originally publishedSeptember 17, 2002 PDF download Advertisement