Abstract
Purpose The purpose of this study was to evaluate various objective, quantitative, time-resolved fluoroscopic imaging parameters for use in the peri-interventional evaluation of stenotic peripheral arterial disease lesions. Material and Methods. Ten patients (median age, 64; age range, 52 to 79; 8 males, 2 females) with high-grade stenoses of either the superficial femoral or popliteal arteries who underwent endovascular treatment were included. During each intervention, two series of intraprocedural fluoroscopic images were collected, one preintervention and one postintervention. For each imaging series, four regions of interest (ROIs) were defined within the vessel lumen, with two ROIs being proximal (ROIs 1 and 2) and two being distal (ROIs 3 and 4) to the stenosis. The time-density curve (TDC) at each ROI was measured, and the resulting area under the curve (AUC), full width at half maximum (FWHM), and time-to-peak (TTP) were then calculated. Results The analysis of the TDC-derived parameters demonstrated significant differences between pre- and postinterventional flow rates in the ROI placed most distal to the stenosis, ROI 4. The AUC at ROI 4 (reported as a relative percentage of the AUC measured at ROI 1 proximal to the lesion) demonstrated a significant increase in the total flow (mean 67.84% vs. 128.68%, p=0.003). A significant reduction in FWHM at ROI 4 (mean 2.93 s vs. 1.87 s, p=0.003). A significant reduction in FWHM at ROI 4 (mean 2.93 s vs. 1.87 s, p=0.003). A significant reduction in FWHM at ROI 4 (mean 2.93 s vs. 1.87 s, Conclusion AUC, FWHM, and TTP are objective, reproducible, quantifiable tools for the peri-interventional fluoroscopic evaluation of vessel stenoses. When compared to the standard subjective interpretation of fluoroscopic imagery, AUC, FWHM, and TTP offer interventionalists the advantage of having an objective, complementary method of evaluating the success of a procedure, potentially allowing for more precisely targeted and quantitatively determined treatment goals and improved patient outcomes. This retrospective study was approved by the local ethics committee under the Number 372/2018BO2. The trial was registered at the German clinical trials register under the number DRKS00017813.
Highlights
Peripheral arterial disease (PAD) is widespread in developed countries and is increasing in both incidence and prevalence worldwide [1,2,3,4]. e characteristic vascular lesions of PAD lead to vessel lumen narrowing and stenosis, resulting in diminished blood flow distal to the lesions and clinical complaints ranging from mild claudication to critical limb ischemia
A range of imaging modalities are employed in the evaluation of these stenotic lesions, including color-coded duplex sonography (CCDS), contrast-enhanced computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA)
Most endovascular procedures performed for the treatment of PAD are guided using a combination of DSA and fluoroscopic imaging
Summary
Peripheral arterial disease (PAD) is widespread in developed countries and is increasing in both incidence and prevalence worldwide [1,2,3,4]. e characteristic vascular lesions of PAD lead to vessel lumen narrowing and stenosis, resulting in diminished blood flow distal to the lesions and clinical complaints ranging from mild claudication to critical limb ischemia. During catheter-directed DSA imaging, endovascular treatments including balloon angioplasty and stent placement can be simultaneously performed [1, 5]. Despite these important advantages, the imaging data provided by the conventional DSA do not directly allow for quantitative measurement of flow conditions or changes in flow, forcing interventionalists to rely exclusively on their subjective impressions of contrast flow during image-guided interventions [3, 5]. Intraprocedural determination of treatment success is defined by subjective assessment rather than the attainment of a quantitative blood flow target While both MRA and CCDS can provide quantitative flow measurements, neither of them can be efficiently implemented intraprocedurally, making them an impractical method of defining treatment success for the interventionalist [6]
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