Csore Judit, Drake Madeline, Karmonik Christof, Benfor Bright, Osztrogonacz Peter, Lumsden Alan B, Roy Trisha L
DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX; Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX.
J Vasc Surg. 2025 Feb;81(2):351-363.e3. doi: 10.1016/j.jvs.2024.08.054. Epub 2024 Aug 31.
Recent randomized controlled trials have demonstrated a notable prevalence of immediate technical failures in percutaneous vascular interventions (PVIs) for complex arterial lesions associated with chronic limb-threatening ischemia. Current imaging modalities present inherent limitations in identifying these lesions, making it challenging to determine the most suitable candidates for PVI. We present a novel preprocedural magnetic resonance imaging (MRI) histology protocol for identifying lesions that might present a higher rate of immediate and midterm PVI failure.
We enrolled 22 patients (13 females, average age 65.8 ± 9.72 years) scheduled for PVI were prospectively and underwent 3T MRI using ultrashort echo time and steady-state free precession contrasts to characterize target lesions before PVI. Lesions were scored as hard if >50% of the lumen was occluded by hard components (calcium/dense collagen) on MRI in the hardest cross-section. Two readers evaluated MRI datasets. Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC)/Global Limb Anatomic Staging System (GLASS)/Wound, Ischemia and Foot infection scoring was performed based on intraprocedural angiograms and chart review. The relationship between MRI scoring, TASC/GLASS scoring, and procedural outcomes was investigated using univariate analysis. Midterm follow-up (revascularization and amputation rates) was recorded at 3 and 6 months after the intervention.
Our cohort of 22 patients yielded 40 target lesions. Five lesions were excluded (two for nondiagnostic image quality; three PVIs were ultimately diagnostic only). Six lesions (17%) were scored as hard. MRI-scored hard lesions had a higher proportion of immediate technical failure (hard vs soft 83% [5/6] vs 3% [1/29]; P < .001). Hard vs soft MRI scoring was the only factor significantly associated with immediate PVI technical success (P < .001), as opposed to TASC/GLASS scoring. Both at 3 months and 6 months after PVI, the reintervention rate was significantly higher among those lesions which were scored hard on MRI (3 months hard, 80% vs soft, 16% [P =.011]; 6 months hard, 80% vs soft, 27%; P = .047).
MRI histology could be a valuable tool for optimizing PVI patient selection and treatment strategies.
近期的随机对照试验表明，在针对伴有慢性肢体威胁性缺血的复杂动脉病变的经皮血管介入治疗（PVI）中，即时技术失败的发生率相当高。当前的成像方式在识别这些病变方面存在固有局限性，这使得确定最适合接受PVI的患者具有挑战性。我们提出了一种新的术前磁共振成像（MRI）组织学方案，用于识别可能出现更高即时和中期PVI失败率的病变。
我们前瞻性地纳入了22例计划接受PVI的患者（13例女性，平均年龄65.8±9.72岁），并在PVI前使用超短回波时间和稳态自由进动对比剂进行3T MRI检查，以对目标病变进行特征描述。如果在MRI上最硬的横截面中，>50%的管腔被硬成分（钙/致密胶原）阻塞，则将病变评为硬病变。两名阅片者对MRI数据集进行评估。根据术中血管造影和病历回顾进行跨大西洋跨学会外周动脉疾病管理共识文件（TASC）/全球肢体解剖分期系统（GLASS）/伤口、缺血和足部感染评分。使用单因素分析研究MRI评分、TASC/GLASS评分与手术结果之间的关系。在干预后3个月和6个月记录中期随访情况（血管再通率和截肢率）。
我们的22例患者队列共产生40个目标病变。排除了5个病变（2个图像质量无法诊断；3个PVI最终仅为诊断性）。6个病变（17%）被评为硬病变。MRI评分的硬病变即时技术失败的比例更高（硬病变与软病变：83%[5/6]对3%[1/29]；P<.001）。与TASC/GLASS评分不同，硬与软MRI评分是与PVI即时技术成功显著相关的唯一因素（P<.001）。在PVI后3个月和6个月，MRI评分为硬的病变再次干预率均显著更高（3个月时，硬病变为80%，软病变为16%[P=.011]；6个月时，硬病变为80%，软病变为27%；P=.047）。
MRI组织学可能是优化PVI患者选择和治疗策略的有价值工具。
