Calcium Burden Assessment and Impact on Drug-Eluting Balloons in Peripheral Arterial Disease
Top Cited Papers
Open Access
- 9 May 2014
- journal article
- Published by Springer Science and Business Media LLC in CardioVascular and Interventional Radiology
- Vol. 37 (4), 898-907
- https://doi.org/10.1007/s00270-014-0904-3
Abstract
This study was designed to assess the effect of calcium on the efficacy of DEB during revascularization of steno-obstructive SFA lesions. Sixty patients with de novo lesions of the superficial femoral artery underwent endovascular treatment with drug eluting balloons (DEB). DEB was selected according to vessel reference diameter (1:1). In case of residual stenosis > 50 % or flow-limiting dissection, postdilatation with conventional balloon or provisional stenting was done. Patients were classified into eight groups according to circumferential distribution of calcium on CT-angiography axial images (from 0° to 360°) and to its length (length < or > 3 cm) evaluated with digital-subtraction-angiography. Ankle-brachial index (ABI), late lumen loss (LLL), target lesion revascularization (TLR), primary (PP) and secondary (SP) patency, major adverse events (MAE), and Rutherford shift were evaluated at 1-year follow-up and correlated with the amount of calcium. Revascularization was successful in all cases. Flow-limiting dissection occurred in five cases (8.3 %) with a higher circumferential degree of calcium and solved in three cases with postdilatation and in the other two with provisional stenting. DEB effect was lower in patients with higher degree of calcium (>270° vs. <90°): ABI 0.71 ± 0.07 versus 0.92 ± 0.07; LLL 0.75 ± 0.21 versus 0.45 ± 0.1; PP 50 versus 100 %; SP 50 versus 100 %; TLR 25 versus 0 %; MAE 25 versus 0 %. Calcium represents a barrier to optimal drug absorption. Circumferential distribution seems to be the most influencing factor with the worst effect noticed in 360° calcium presence.Keywords
This publication has 26 references indexed in Scilit:
- Percutaneous Treatment of Peripheral Artery DiseaseCirculation, 2012
- Pilot Trial of Cryoplasty or Conventional Balloon Post-Dilation of Nitinol Stents for Revascularization of Peripheral Arterial SegmentsJournal of the American College of Cardiology, 2012
- Comparison of Orbital Atherectomy Plus Balloon Angioplasty vs. Balloon Angioplasty Alone in Patients With Critical Limb Ischemia: Results of the CALCIUM 360 Randomized Pilot TrialJournal of Endovascular Therapy, 2012
- Combined treatment of heavy calcified femoro-popliteal lesions using directional atherectomy and a paclitaxel coated balloon: One-year single centre clinical resultsCardiovascular Revascularization Medicine, 2012
- 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (Updating the 2005 guideline)Catheterization and Cardiovascular Interventions, 2011
- The role of vascular calcification in inducing fatigue and fracture of coronary stentsJournal of Biomedical Materials Research Part B: Applied Biomaterials, 2011
- ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries * The Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC)European Heart Journal, 2011
- De Novo Superficial Femoropopliteal Artery Lesions: Peripheral Cutting Balloon Angioplasty and Restenosis Rates—Randomized Controlled TrialRadiology, 2008
- Angiography Underestimates Peripheral Atherosclerosis:Lumenography RevisitedJournal of Endovascular Therapy, 2008
- Contribution of localized calcium deposits to dissection after angioplasty. An observational study using intravascular ultrasound.Circulation, 1992